Anticipatory grief is a term that refers to grief experienced before a major loss like death or during an ongoing period like a prolonged illness or dementia. When a person or family member is nearing death, it is normal to begin to anticipate how you will react and cope when that person eventually dies. You may find that you will try to envision your life without that person and think about how you will feel in the future, which may include grief reactions and ways you will mourn and adjust after the death of a loved one.
Anticipatory grief – also known as anticipatory mourning – includes feelings of loss, concern for the dying person, balancing conflicting demands, and preparing for death. Anticipatory mourning is a natural process that enables you and other members of your inner circle time to slowly prepare for the reality of the loss.
The Messiness of Anticipatory Grief
The concept of anticipatory grief has become well-known and is beginning to be studied and written about, sometimes as though it is a predictable and universally experienced phenomenon. The reality is that grief of any kind is messy, complex, and highly individual.
Although there may be a common universe of experiences and feelings, each person and situation is different. Relationships vary from close and loving to hateful and distant; families vary from tightly connected to barely in contact, and all the increments in-between. Whatever tensions, gaps, or ambivalence existed before the impending death or ongoing decline, they will be intensified as death nears or decline is precipitous.
Sometimes this time allows for completing unfinished business with the dying person, or simply saying things that are important to say like “I love you, “I forgive you, “forgive me”, “I did not understand”. Other times words are not necessary or even advisable. Sometimes it feels like you are working through the feelings, other times you are back where you were 3 weeks (or months) ago. And all this may be happening within a family system that is not without its own challenges.
There is no right or wrong way to experience anticipatory grief. Below are descriptions of stages of grief that may (or not) be helpful in understanding your process. If they don’t resonate with you, do not be concerned, your experience is completely normal, whatever it is.
What Are the Stages of Anticipatory Grief?
Researchers have coined the four stages of anticipatory grief as:
- Stage 1: Acceptance. During this stage, you recognize that a loved one’s death is unavoidable. You may feel emotions such as sadness, denial, anger and experience depression.
- Stage 2: Reflection. This is when you start to come to terms with how you’re feeling. In addition to feeling anger, you may also feel regret, guilt and remorse.
- Stage 3: Rehearsal. As you go through this process, you start to think about how you’ll feel during and immediately after the loss. For example, with a loved one’s death, you think about how you’ll act and what things you may need to do such as make funeral arrangements.
- Stage 4: Imagining the future. During this stage, you begin to visualize what your life will look like after the loss.
Anticipating Loss and Grieving Something As It’s Happening
What is not often discussed is that many situations are quite complex and the grief is not uniquely focused on the impending death. In certain situations, such as dementia or a lengthy, terminal illness, more complicated, nuanced feelings are elicited. While the death is anticipated, real losses are ongoing.
Anticipatory grief, especially in the context of dementia or progressive illnesses, is complicated since there is both the anticipated future loss, but also ongoing, present losses. The caregiver may feel that they have lost the life they had before caregiving, in addition to the future they imagined. The present losses may include changes in the quality of relationships and in the quality of life. These losses are real and acknowledging them (even just to oneself) is valuable.
Coping with Anticipatory Grief
The feelings of grief are complicated, messy, painful, and sometimes persistent. Managing them on top of all the tasks of caregiving can become overwhelming. It is in those moments that it is so important to take a few moments for yourself, whether it’s:
- finding a quiet place to just breathe
- listening to music
- or taking a walk
You will have your own activities to add to this list. Just remember to find the time to do whatever brings you moments of peace.
If you’re having difficulty and feeling overwhelmed by grief, leading to thoughts about harming yourself, please call 911 or the national crisis hotline at 1-800-273-8255.
Dealing with Social Isolation
Experiencing anticipatory grief can make someone feel socially isolated because others may not fully grasp the unique challenges of their situation. Friends and family may struggle to offer appropriate support or understand the nuances of this type of grief, leading to a sense of loneliness. Many people have trouble hearing about situations that can’t really be fixed. Journaling may help, as can sharing with a person or group that has also experienced the challenges of caregiving.
Finding Moments of Intimacy to Manage Your Feelings
Of course, relationships change during this time. One person is slowly dying or losing themselves in dementia, while the other person is managing most everything else — including their grief. Still, there may be intimacy and comfort to be had.
Depending on the relationship and the people involved, sometimes the realities of the situation and the feelings may be discussed. Quiet companionship, with loved ones or the one being care for, can be comforting when it is difficult to name what is going on.
While coping with anticipatory grief, the goal is not perfection or perfect control; it is finding a way through that is authentic and manageable. Even just sitting with all that is going on can bring some peace.
We have guidance and information on where to get grief support and ways to talk with your inner circle that can help with grieving.
