Anticipatory Grief: Preparing for the End

What do we know about grief? Well, it is the response of pain of loss of something that we have formed a strong bond and affection with – be it somebody like a loved one, family member or a friend; or any other change that alters life as you know it like the loss of a pet or a job etc. It is universal and we all will have at least one encounter with it throughout our lives.

Though we think of grief as something that happens after that incident, it often starts before the incident happens – mostly on the matter of death. It is natural that we begin to grief even before the death situation occurs, knowing that it is on the horizon.

We will further explain on this kind of grief called anticipatory grief.


What is Anticipatory Grief?

Different people experience grief in different amounts and the grief experienced before a death does not make the grief after the death last a shorter amount of time. For most, if not all of us, we have a lingering sense that more loss is still to come

So what exactly is anticipatory grief? It is the grief that happens before the death or loss takes place. It is common among people who are facing the eventual death of a loved one or their own death.

Let’s take a common example: a loved one is diagnosed with an incurable disease like advanced cancer, we will naturally be preparing ourselves when ‘their time comes’. As the illness progresses, some of us will start to feel that the person is already ‘lost’ to us.

The preparation for a loved one’s end of life or a major loss is what defines anticipatory grief. We are aware of the looming death and also accepting that it will happen. This can bring overwhelming emotions like sadness, anxiety and dread. In advance of a death we anticipated, we grieve the countless other losses for the other person like their loss of basic abilities and cognition, their unfulfilled future dreams etc., as well for ourselves with the loss of freedom and independence as we try to make up as much time with them before they ‘leave’. This can also lead to guilt.

This anticipatory grief is not just about accepting the future death, but of the many losses already occurring as an illness progresses.

Anticipatory Grief vs Conventional Grief?

While most people are familiar with the conventional grief that occurs after a death, anticipatory grief is not often discussed. Grieving is not just something that happens after someone passes away and anticipatory grief is different than the grief that follows a death.

Anticipatory grief can often be mixed in with hope that your loved one will live longer or survive their illness, while conventional grief indicates that a loss has already occurred. There will be times that anticipatory grief may reduce the intensity of grief following a loss, then there are many times that the grief following a death is not impacted at all.

Symptoms of Anticipatory Grief

While anticipatory grief shares some commonalities with conventional grief namely the feelings of sadness, anger, depression, isolation and etc., some symptoms are unique to anticipatory grief. These complicated emotions are often coupled with the stress of being left alone and probably the exhaustion that comes with being a caregiver.

The below are some of the common symptoms of anticipatory grief among others:

  • Secretly hoping the situation could be over which leads to the guilt and shame.
  • Anxiety, worry and hopelessness with a loss of control.
  • Increased concern for the person being cared for.
  • Sense of looming dread.
  • Getting constantly stuck in between hope and despair.
  • Fear with the thoughts of how life will look and feel like when the person dies.
  • Enhanced irritability, anger at the unfairness of life and the situation you are put into.
  • Bargaining: creating various ‘if only’ scenarios in your mind like different attempts in adjusting to the consequences of the loved one’s end of life
  • Losing touch with your loved ones who are well and thriving, because all your energy is going towards the person dying.
  • Depression and etc.

Stages of Anticipatory Grief and Conventional Grief

Grief is different for every person and not everyone will experience all five stages of grief, but there are some commonalities in the stages and the order of feelings experienced during grief. Some of those common feelings include anger, bitterness and resentment because you are forced to come to terms with the fact the outcome cannot be changed in such difficult situations.

Some may not go through them in the exact same order, so you may begin coping with loss in the bargaining stage and find yourself in anger or denial next. You may remain for months in one of the five stages but skip others entirely.

Anticipatory GriefConventional Grief 
Experiencing shock about the upcoming lossDenial
Denying the reality of the lossAnger
Eventual acceptanceBargaining
 Depression
 Acceptance

How to cope with anticipatory grief?

Because of not many people talking about anticipatory grief and only is aware of the conventional grief, some people find it socially unacceptable to express the deep pain they are experiencing and fail to receive the support they need.

During this COVID-19 pandemic, international borders are shut. Some of us are mostly away from family and when we receive unexpected news about a loved one ‘not doing well’, the inability to do anything about it or travel to visit one last time will surface and contribute to the symptoms of anticipatory grief.

Grief is very personal and it doesn’t follow any timelines or schedules. You may cry, become angry, withdraw, feel empty and it is important to understand and know that none of these things are unusual or wrong.

While understanding what is anticipatory grief and its symptoms, here are some ways that you can consider to best cope at this difficult time.

  1. Acceptance: Accept that anticipatory grief is normal and you are allowed to feel this type of grief before a death.
  2. Acknowledge: Face the fact that what you are experiencing is true, and though the person is still there, you are already grieving. Try out different outlets in expressing your pending emotions of death, loss of hope and many other feelings – like journaling, art, photography. Another way is also to explore mindfulness meditation, a way of keeping yourself in the present and being aware of the various emotions you are facing.
  3. Connect and Communicate: You are never alone in these situations. Always speak out to somebody you trust, or a support group/ support system that you have that understands what you are going through. Create various discussions together for the constant feelings of grief. Keep your family members and friends close as well for better understanding of one another.
  4. Reflect: Consider the remaining times as the best times of spending together with your loved one. If they are open to it, you may discuss on practical matters like other future arrangements or any wishes they would like you or somebody else to honour. Create a closure for yourself and the loved one like saying the things that you want and need to say to them, while forgiving each other and bringing yourself to say goodbye when and while you still can.
  5. Relief: Remember that feeling relieved after an anticipated death does not mean you are heartless and loved that person any less. It is a normal reaction after a stressful and overwhelming time in your life. Don’t let that guilt eat you up for it.
  6. Self-Care: This is the ultimate reminder to keep yourself in check while you continue to be physically and mentally strong in caring for the loved one. Remember, you cannot take care of others if you do not take care of yourself first. Get enough sleep, eat healthily and rest when needed.
  7. Counselling: Mental health is an important factor in our lives now, and it is not frowned upon anymore to get the help that you need. Go for a counselling session with a trusted and certified therapist if you think that it is too much to handle. Explore WhatsDoc’s list of psychotherapists and counsellors who are ready to assist you in overcoming your grief – step by step.

WhatsDoc has a list of certified psychologist that have experience in managing Symptoms of Anticipatory Grief. Let us be part of your healing journey from the comforts of your own home.

References:

https://www.medicinenet.com/anticipatory_grief/definition.htm

https://en.wikipedia.org/wiki/Anticipatory_grief

https://www.healthline.com/health/stages-of-grief

https://www.verywellhealth.com/understanding-anticipatory-grief-and-symptoms-2248855

https://www.aplaceformom.com/caregiver-resources/articles/anticipatory-grief

https://www.webmd.com/palliative-care/caregiver-grief-and-bereavement

https://www.psycom.net/anticipatory-grief

https://www.vnsny.org/article/5-steps-for-dealing-with-anticipatory-grief/

https://www.mariecurie.org.uk/blog/what-is-anticipatory-grief/271278

https://www.lungcancer.org/find_information/publications/385-anticipatory_grief_preparing_for_a_loved_one_s_end_of_life

https://www.healthline.com/health/mental-health/how-anticipatory-grief-may-show-up-during-the-covid-19-outbreak#If-youre-feeling-anticipatory-grief,-what-can-you-do-to-cope?