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What is Anticipatory Grief?

Anticipatory Grief: a Definition

Most people think of grief as something that happens after a loved one’s death. But grieving can also occur before death. This experience is known as anticipatory grief, because it occurs in anticipation of a death or other type of loss — such as the loss of abilities or independence. Anticipatory grief can be experienced by loved ones, as well as the person who is ill or dying.

What are the Symptoms of Anticipatory Grief?

Anticipatory grief has similarities and differences with conventional grief.

The emotions are comparable with both types of grief, but anticipatory grief can be even more of a roller coaster. You may feel very sad on some days, and not experience any grief on others. You may even feel guilty over your shifting emotions. However, this is very normal, and it does not mean you love the person any less. Everyone grieves differently; there is no right or wrong way to mourn.

Another challenge of anticipatory grief is that it can be mixed with hope that the person will live longer than expected — or even survive their illness. This can contribute to the up-and-down nature of anticipatory grief.

The most common symptoms of anticipatory grief include:

  • Depression. This condition is characterized by persistent feelings of sadness, anxiety, or “emptiness” lasting for at least two weeks. Depression can have many other symptoms, too — from fatigue to restlessness, insomnia to oversleeping, and even physical pain.
  • Anxiety. This emotional state is marked by feelings of tension and worry. It can cause physical symptoms, including raised blood pressure, trembling, and heart palpitations.
  • Irritability and anger. You may experience your own anger, plus the challenge of coping with your loved one’s anger.
  • Increased concern for the ill person. You may worry over a variety of issues, including emotional, physical, or spiritual matters.
  • Thinking about what the person’s death will be like. You may imagine what your life will be like after your loved one’s death. If you are dying, you may focus on how your loved ones will go on without you. These are normal parts of the process of accepting loss.
  • Mourning over changes in the loved one’s personality or appearance.
  • Sadness and crying. Tears can come unexpectedly. Random sights, sounds or thoughts — such as a TV commercial or photograph — can suddenly remind you of your impending loss.
  • Fear. It’s common to be afraid of your loved one’s death and the changes their loss will bring.
  • Loneliness. Close family caregivers often feel deep loneliness before their loved one’s death. They may be reluctant to express grief while their relative is still alive, which can add to their feelings of isolation.
  • A need to talk. You may feel a strong desire to share your feelings with someone who can understand and listen without judgment. It’s important to find a support network or seek out a mental health professional, if needed.
  • Guilt. Many people feel intense guilt before a loved one’s death. For instance, you may wish for the person’s suffering to end, which would also mean their life would end. You may feel guilty that your life will go on after their death – a feeling called “survivor guilt.” And you may have guilt over past behavior or conflicts involving your loved one. You may also have guilt that you can still enjoy what your loved one cannot.
  • Bodily problems. You may have trouble sleeping, changes in eating patterns, memory problems, and aches and pains —such as headaches, backaches, or neck or chest pain.

Purpose of Anticipatory Grief

For the person who is dying, anticipatory grief can help them focus on what’s most important to them, and address any unresolved issues. It can help the person find meaning, achieve closure, and feel at peace.

For family members, anticipatory grief can also provide an opportunity to reconcile differences and attain closure. For both patient and loved ones, it presents a chance to say goodbye.

Some people are reluctant to visit a loved one who’s dying. They may want to avoid the emotional pain, or wish to remember the person “the way they were” before their illness. However, anticipatory grief presents important opportunities for healing. Spending time with your loved one while they are weak and failing can help you accept their death. It can make it slightly easier to let go — and tell your loved one it’s OK for them to let go, too.

Here are some additional ways of coping:

  • Focus on quality of life. Shift away from hope for recovery, and toward hope for smaller, achievable goals. For example, aim for your loved one to have a “good” day, in terms of how they’re feeling.
  • Form a support network. A person’s impending death is difficult for everyone who loves them. Ask each other for help and support. This will strengthen the bonds between you and create a supportive community. This network will help you cope both before and after your loved one’s death.
  • Connect with your loved one. Spending quality time together can bring comfort to each of you. Seek out activities you’ll both enjoy — whether simply talking, listening to favorite music, or doing “bucket list” activities.

When to call your doctor
If your grief is overwhelming and you’re unable to cope, contact your doctor or mental-health professional.

  • Don’t wait! Address unresolved issues between you and your loved one. Say what you need to say, in order to resolve or accept differences between you and achieve closure. As Dr. Ira Byock writes in “The Four Things that Matter Most,” there are four simple phrases: “Please forgive me,” “I forgive you,” “Thank you,” and “I love you” —that carry enormous power to mend and nurture our relationships and inner lives. These four phrases and the sentiments they convey can help us resolve interpersonal difficulties with integrity and grace.
  • Resolve legal and financial matters, and discuss end-of-life wishes, if your family member is still well enough for these conversations. In this way, anticipatory grief can help you and your loved one prepare for their death. (For more information on advance planning, visit Samaritan’s End of Life Conversation Resources.)
  • Get professional support. Your loved one’s health professionals — such as their hospice nurse, doctor, or social worker — can provide emotional support and guidance to you and your loved one.
  • Learn what to expect. Educate yourself about your loved one’s illness, including symptoms, side effects from any treatments they’re receiving, and progression of their disease. You may feel less anxious and better prepared by knowing what’s coming.
  • Help your loved one adjust. Your family member may be struggling with changes in their abilities or identity. Listen and acknowledge where they are and their feelings about it. Seek new activities they may enjoy, or find ways they can still connect with their past passions. For instance, a Samaritan patient was a lifelong pianist, but could no longer sit at the instrument. His caregivers got him a portable keyboard, which he played from his bed — providing hours of enjoyment for himself and his loved ones.

You can also do things for yourself that will help reduce stress and improve well-being.
For instance:

  • Take the time to do things you enjoy.
  • If you’re a caregiver, seek help from family members, friends, a hospice volunteer, or a paid aide, so you can take breaks from caregiving.
  • Take short walks as often as possible. Moving your body helps manage emotion.
  • Keep a journal.
  • Postpone chores when feasible, so you can spend more time with loved ones.
  • Seek spiritual support.

If you live in South Jersey and have questions about grief support or end-of-life care, please call Samaritan at (800) 229-8183.