It’s Not a Broken Heart: The Biological Bases For Illness and Mortality Post-Bereavement

I have nothing against William Cowper.

A wildly popular 18th century poet, greater poetic minds than mine–Samuel Coleridge, William Wordsworth–thought he was the cat’s pajamas.

But when he leaves his subject base of nature and Christianity and steps his foot into medical theory, well, we have a parting of the minds.

“Grief is itself a medicine,” he wrote.

The scientific truth: Grief suppresses parts of the immune system, leaving mourners more open to infection–and, possibly, mortality.

Take that, my friend Cowper.

And the rest of us should realize that from this biological truth was born a common belief: That one can die from a broken heart. It sounds more romantic that way, but it looks, if research is accurate, like mourners are instead dying of infection which their losses have left them ill-equipped to battle.

After great pain a formal feeling comes/The nerves sit ceremonious like tombs ~Emily Dickinson

What is that formal, uncomfortable feeling Dickinson addressed, that feeling that something is not right, that all is not at ease in your body? Well, it just might be your immune system taking a vacation on you.

Research has repeatedly confirmed that the bereaved both suffer more physical and emotional illnesses and tend towards earlier mortality than their non-bereaved counterparts. It’s now accepted as a truism that “vulnerability to physical illness and mortality are increased during the first 2 years of bereavement” (Biondi & Picardi).

Several years later, Spratt and Denney analyzed 9 parents (aged 38–61 yrs) who had suffered the sudden death of a child, and looked for immunological changes 2, 4, 6, and 8 months postbereavement. [Nine nonbereaved controls were also examined.] The bereaved parents showed, as suspected, significantly decreased T-regulatory cells, which help maintain immunological tolerance.
Just for starters, Irwin et al compared a group of women whose husbands had died recently with age-matched women who had not experienced bereavement. They found that natural killer (NK) cell activity, a component of the immune system, was significantly lower in the systems of the bereaved women, thus making them vulnerable to illness and infection.l

In a fascinating review of the literature, Goforth et al, in their study titled “Impact of bereavement on progression of AIDS and HIV infection: A review,” analyzed the current research on grief, HIV, and immunity.

They discovered that patients who experienced maladaptive grief, or grief that didn’t remit within expected periods of time, showed more rapid loss of CD4 T-cells [named thus because they have  molecules called CD4 on their surfaces. They are a type of “helper” cell, and are responsible for initiating the body’s response to infections. Particularly in the HIV patient, the fewer the functioning CD4 cells, the weaker the immune system–leaving the patient more susceptible to infection and illness.]. Thus the bereaved actually deteriorate more rapidly during the course of their illness, seemingly as a result of their mourning and its biological impact.

In a fascinating component of this discovery, these cells dropped in the bereaved subjects, even when health status, age and the use of antiretrovirals were controlled for. It seems that the power behind the emotion of grief is stronger than the best medications we currently have to offer.


And what of the interesting study on, of all things, not the ill, but the well, working on preventing illness? Examining the flu shot and its efficacy, Phillips et al took a look at a group of 184 elders for responsiveness, given a variety of variables, one of which was bereavement (others included marriage, social support, and general satisfaction). They assessed antibody response at baseline, at 1 month, and then 12 months following the vaccination.

And what should they find? Bereavement, raising its complicated head again, made a difference. If the subjects were bereaved in the year prior, they had a poorer antibody response to the vaccination, even more so than those who had, say, low levels of satisfaction. (A fascinating side point: Marriage was associated with better response. Take that, Commitment Phobes!)

And, finally, a most recent article that has been getting a lot of play–Britian’s unusual “Telegraph,” the blogosphere–addresses the interplay between bereavement and a crucial part of your white blood count–a tiny cell you may never have heard have, but really should have a passing acquaintance with, given the heavy lifting it does in your immunological health.

To return. . .Khanfer at al studied the relationship between neutrophils and bereavement in the elderly, aged 65+, who had been very recently bereaved. These 24 subjects were matched with controls of the same age, who had not suffered the stress of such losses.  And the researchers indeed discovered that neutrophil production was significantly reduced among the bereaved; the cells were thus not as responsive when infection was introduced, in comparison to the controls’ cells.Meet the neutrophil. It’s a tiny white blood cell, the most abundant type of white blood cell we’ve got, and it helps your immune system fight off infections, particularly of bacteria and fungi. It’s got a good beat–you can dance to it–I give it a perfect 10. Neutropenia, or an abnormally low count of neutrophils, can come from illness or medications or treatments–particularly cancer treatments–and it’s a serious matter.

Said Professor Janet Lord, who led the research: “There are a lot of  anecdotes about couples who were married for 40 years when one of them   passes away and then the other dies a few days later. It seems there is a biological basis for this.

“Rather than dying of a broken heart, however, they are dying of a broken  immune system. They usually get infections.”

Just to be clear, this doesn’t absolve those people who come at the mourner with the old and odious, “no one ever died of a broken heart.” People are still required to have a modicum of sensitivity and compassion.

And, in my mind, there is a connection between that broken heart and the weakening neutrophils. What the body is saying is: “This pain that I’ve suffered is so awful, parts of me are shutting down. I’m losing my ability to function in my grief.”

It is our duty to hear that pain, expressed in illness, and do all we can to ease the burden of those suffering. Grief is no medicine–it can be a pill with deadly side effects.


Biondi M, Picardi A. Clinical and biological aspects of bereavement and loss-induced depression: A reappraisal. Psychotherapy and Psychosomatics 1996; 65(5):229–245.

Goforth H, et al. Impact of bereavement on progression of AIDS and HIV infection: A review. Psychosomatics 2009; 50(5):433–439.

Irwin M, et al. Impaired natural killer cell activity during bereavement. Brain, Behavior, and Immunity 1987; 1(1):98-104.

Khanfer R, Lord J, Phillips A. Neutrophil function and cortisol:DHEAS ratio in bereaved older adults. Brain, Behavior, and Immunity 2011; 25(6):1182–1186

Phillips A. Bereavement and marriage are associated with antibody response to influenza vaccination in the elderly. Brain, Behavior, and Immunity 2006; 20(3):279–289.

Spratt M, Denney D. Immune variables, depression, and plasma cortisol over time in suddenly bereaved parents. The Journal of Neuropsychiatry and Clinical Neurosciences 1991; 3(3):299-306.


I help adults and adolescents through the particular struggles of our time: tension between couples, parenting frustration, blending new families, separation and divorce, (un)employment, cancer, and loss. When relationships come to an impasse, I use mediation techniques to try to ensure that each party will have his/her needs heard and accounted for in a dignified way. In addition to talking, listening, and reframing, I utilizes the tools of metaphor, active teaching, role-playing, visualization, and hypnotherapy.for families and businesses, as well as in cases of divorce.

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