Anticipatory Grief

Anticipatory grief may arise when someone is seriously ill or dying. It also happens when a friend or family member experiences the suffering of a loved one. This pain and sorrow is anticipatory grief.

It’s normal to feel shocked or devastated. A diagnosis of serious illness may set off complex emotions in the family, ranging from fear to depression.

Anticipatory grief can be just as intense as the grief felt after a death. It’s a normal process, although not every person experiences it. Grieving now does not mean that you will feel more or less grief after death. Every person reacts differently.

You may experience fear, guilt or anxiety. You may fear being alone, fear losing your independence or your social life. These fears are not limited to family and caregivers and even the person who is sick may feel a sense of fear and isolation.

Anticipatory grief is often combined with the exhaustion that comes with being a caregiver. You are aware of the coming death and recognizing that can bring anxiety and dread.

It’s not just death for which you grieve. During sickness you grieve any loss of abilities and independence, loss of cognition, loss of hope, loss of future dreams, loss of stability and security, loss of identity and more. This grief is not just about accepting the future death, but of the many losses already occurring as an illness progresses.

Preparing yourself

This period before a death can help family members prepare for what will happen after death. It can give you an opportunity to spend time with your loved ones, express love and even forgiveness, and to figure out how to let go.

Anticipatory grief can include all of the symptoms you might expect after a loss, like sadness, anger, isolation, forgetfulness, and depression. But, some things are more common for those experiencing anticipatory grief:

worry about the person dying
imagining what the death will be like
imagining what life will be like without our loved one
desire to deal with unfinished business with the dying person

When you know death is near, you may experience hyper-alertness at sounds like a phone ringing or any time you are away. This can be mentally and physically exhausting. Caring for a loved one as they suffer takes an emotional toll.

These situations can contribute to a sense of relief when the death eventually comes, and a guilt that often comes with that relief. These feelings are common and totally normal when someone has experienced an anticipated death. You may need to remind yourself that the relief does not change the deep love you had.

Anticipatory grief is normal, but it may interfere with your day-to-day well-being. Don’t be afraid to let yourself feel the pain of grief. Acknowledge your feelings of fear and loss, and remind yourself that they are normal in this situation. It does not mean you are giving up or that you love the dying person any less. If you are having trouble coping with your feelings, there are many strategies and resources available to help you get through anticipatory grief.

Strategies

Find an outlet for your feelings – talk to a friend or family member or a spiritual adviser. Join a support group or express yourself by journaling, letter writing, or artwork.
Take care of yourself – work to stay physically healthy. Get enough sleep, eat nutritious food and exercise. Attend to your spiritual needs through prayer, meditation, yoga, long walks or whatever works for you.
Spend time together now – make that time meaningful, spending time together in ways that are significant to you, whether that’s going through photos or simply being there. Your presence alone may be the best gift.
Learn coping skills – seeking healthy coping strategies online can be useful. The Alzheimer’s and ALS associations, as well as Cancer support organizations can be a source of information and ideas.
Open your heart − although painful, a terminal illness offers you time to say ‘I love you,’ to share your appreciation, and to make amends when necessary. If you’ve had an unexpected death, you know that people often regret not having had a chance to do these things. Also, sometimes the dying person hangs on because of a feeling that others aren’t ready to let them go. Giving them permission to die, knowing that you will carry on, can impart a sense of profound relief. Read more about saying goodbye.

If you are having difficulty coping, don’t hesitate to contact your care team social worker, chaplain, or grief support specialist. Anticipatory grief can be painful, but nobody has to suffer it alone.