Anticipatory grief

When someone you love has a prolonged illness like cancer, you can begin grieving the loss of the person long before the time of his or her death.

What is anticipatory grief?

Grief is an emotional reaction to loss. When a loved one dies, you grieve the loss of someone important to you.

Anticipatory grief is an emotional reaction to loss that you know will occur, but has not yet occurred. For example, if you know a loved one is going to die, you may feel anticipatory grief for the loss of that person, even before he or she has died.

Anticipatory grief is a normal reaction to impending loss. It's how people learn to cope with the extended care and the eventual loss of a loved one. Learning to live with an impending loss on a daily basis can be one of the greatest challenges that a carer will face.

Emotions

While it can involve many of the same emotions often associated with grief, like anger or denial, anticipatory grief occurs less suddenly and may become increasingly powerful over time.

Often, anticipatory grief will bring with it:

  • Depression
  • Extreme concern for your loved one
  • Preparation for death
  • An attempt to adjust to the consequences of the death

If the death is drawn out over a long period, you may feel waves of intense grief, alternating with times of numbness. This has been referred to as the body's "stop and go" signal. The body, unable to cope with the physical and emotional strain of sustained, intense grief, will self-protectively block out emotions like sadness and anger for a period, giving you an emotional respite from the pain. Then, with each downturn in your loved one's health or each new development, the grief may resurface.

Like grief, anticipatory grief may involve acceptance of the death. Although this is a normal part of the grieving process, some carers may feel guilty about having accepted the death, as if they have abandoned their loved one.

Unlike a sudden death, an anticipated death gives the family more time to slowly get used to the reality of the loss. Knowing about the inevitable, even if you don't know when it will occur, might also bring you closer to your loved one. It might provide a time for you to resolve any regrets, or let go of any anger or guilt you may feel and make amends. It can give you a chance to complete unfinished business, like saying "good-bye", "I love you", or "I forgive you". It can also provide an opportunity to discuss taboo topics such as the funeral or what happens for you after the person you are caring for dies.

After death

Anticipatory grief allows time to come to terms with the inevitable, but it doesn't lessen the impact of your loss when your loved one dies. You will still feel grief when your loved one dies, and the anticipatory grief experienced before the death will not necessarily make the grief after death last a shorter time.

Carers have reported that there is a sense of relief when death finally comes, but this is often mixed with feelings of fear, sadness, confusion, doubt, guilt or blame as well.

What to do if you are experiencing anticipatory grief

Some tips for managing anticipatory grief:

  • Recognise that anticipatory grief is a normal reaction to loss and coping with the care of a loved one.
  • Don't feel guilty about anything you may be feeling. Instead make the best out of each moment you can spend with your loved one.
  • Try to focus on the positives.
  • Talk about how you are feeling. You can do this with your loved one, family, friends, or other support professionals such as a counsellor.

Resources

Weber, Z. A. (2001) Good Grief - How to recover from grief, loss or a broken heart (MG Publishing: Double Bay)

Strength for Caring, What is Anticipatory Grief?

National Cancer Institute, Anticipatory Grief