Anticipatory grief: learn the signs and how to deal with them

Anticipatory grief: learn the signs and how to deal with them

Anticipatory grief: learn the signs and how to deal with them

Mourning a loss that is expected but has not yet happened can be a unique challenge. Here’s how to recognize and deal with anticipated grief.

sadness for what is to come

“My grief feels like fear,” says Anna Raway, 38, of Lakeville, Minnesota. In recent years, she has watched her beloved mother disappear into the fog of Alzheimer’s disease.

There is a certain sadness about what is happening now. Her normally patient and loving mother has started throwing angry outbursts.

“She said and did things that hurt my feelings and I didn’t know how to deal with them,” says Raway. “Also, she can’t remember a lot of things and that hurts too because nobody wants to see their parents fight like that. I cried a lot.”

But there is another element in her grief that she finds difficult to identify: a sense of heavy sadness not only about what is happening now, but also about what is inevitably to come.

“Every time I call or visit her, I worry that she doesn’t remember me or my family, that she feels lonely because she forgot we visited her, and I hate it most of the time Seeing her suffer in confusion because I know it’s only going to get worse until…” she says.

Alzheimer’s disease lasts until death.

What is anticipatory grief?

How do you mourn someone who hasn’t died yet but will die soon?

There’s a name for that confusing, frustrating, scary feeling that Raway describes — and it’s far more common than you might think, says Gail Trauco, a board-certified oncology nurse and licensed grief mediator who has helped hundreds of patients and their families, to cope with this painful process.

Anticipatory grief is the process of mourning an anticipated future tragic event, often the death of a loved one from a terminal illness, explains Ashwini Lal, senior clinical psychologist at Kaiser Permanente’s Bernard J. Tyson School of Medicine.

“It’s uniquely painful [that] what is mourned still exists,” he says.

Grief comes from the anticipation of loss, not the loss itself, and that can be confusing, says Abigail Nathanson, a licensed social worker certified in palliative care and a professor of grief and trauma at New York University.

She adds that there are other ways to feel anticipated grief. For example, a senior graduating high school may experience a form of “senioritis,” mourning the impending unofficial end of childhood and the transition to adulthood.

(Here’s how a young woman deals with anticipated grief and loss after losing her husband to brain cancer.)

signs of anticipated grief

All grief mourns some type of loss, and the process of grieving—although different for each person—generally follows a similar pattern. There are many different models of grief, but broadly speaking, people can expect to experience denial, anger, negotiation, depression, and acceptance.

fault

Grieving in general isn’t as easy as it sounds, and when you add in the anticipation of grief, it can feel even more complicated, says Nathanson. People who experience this type of grief often have heightened feelings of guilt.

Mixed feelings

“Maybe you’ll beat yourself up and think, ‘I should enjoy whatever time I have left with them.’ You may even feel like your grief is “giving up” on your loved one,” says Nathanson. “There can be a lot of self-judgment in anticipatory grief.”

conflict

This type of grief also brings with it some uniquely difficult circumstances, Trauco says.

There are the practical aspects of knowing someone is going to die that need to be attended to, such as end-of-life planning, final wishes, disposal of property, and bodily adjustments. This can lead to anxiety and stress, and it’s not uncommon for family conflicts to increase during this time — which can add to the expected grief, she says.

(This is how happy memories of loved ones make you healthier.)

Woman holding sister's hand in hospital bed

HRAUN/Getty Images

Symptoms of anticipated grief

Although some of the responses in the grieving process are similar to general grief, anticipatory grief tends to involve a greater risk of depression and anxiety, increased concern for the dying person, and attempts to adjust to the expected consequences of death, Lal says.

Because of the stressful and sometimes extended nature of this type of grief, some physical symptoms associated with chronic stress can include stomach problems, overeating or malnutrition, an increase in addictive behaviors, chest pain, and alcohol abuse, Traco says.

Dealing with anticipated grief

“The goal of grief is not ‘How do I stop being sad?’ but ‘How do I wear this and still live my life meaningfully?’ says Nathanson.

There is no one “right” way to mourn, nor is there a recipe for how to deal with it. But there are some things that many people find helpful during the process, she says.

name it

The first step to dealing with this type of grief is to identify it for what it is, Nathanson says.

Knowing that you’re grieving the anticipated loss can help you identify and understand the source of your feelings, rather than trying to push them away or telling yourself that this is how you “should” feel.

If you feel bad about your negative feelings, it will only make you feel worse. Identifying your feelings and the cause can help you process them.

Allow yourself to feel it without judging it

“Understand that there is no limit to grief — grieving now doesn’t mean you will grieve less later,” says Nathanson.

You may feel guilty or uncomfortable at the thought of mourning someone who is still alive. But your experience is legitimate, and it’s important to acknowledge your feelings of grief, Lal says, adding that it’s also normal to feel relief after someone dies.

talk about it

One of the best ways to deal with any type of grief is to talk about it with others who understand, Lal says. Often these are others who are close to the person for whom you feel anticipatory grief, but sometimes not always.

Friends who are further away from the situation, hospice counselors, and/or members of support groups are all great people to talk to about your grief. Raway says she finds it very comforting to share her feelings with others.

Plan meaningful activities

Depending on the situation — such as how ill your loved one is — plan activities to do together to create fond memories during this time, Lal says.

This includes things like playing a favorite game, taking lots of photos, going on adventures, keeping a journal, and making videos together.

This type of grief also offers some unique benefits, says Trauco.

“Expectant grief can be helpful in some ways because it motivates you to prepare for the loss, gives you time to say goodbye, and can lead to peace and a sense of resolution and acceptance,” she says.

take care

Eat a nutritious meal, go for a walk outside, get plenty of sleep, and take a hot bath. All of the self-care chores that used to be nice become necessities when you’re grieving, says Trauco.

(You may also find solace in quotes about pain and how to deal with it.)

Put it in perspective

Birth and death are the universal experiences of this life, and so each person must find a framework to deal with these big issues.

Many people find that perspective and meaning in religion or spirituality, but the most important thing is finding what feels right for you, Lal says.

Cultural or religious traditions can help. (Here’s what you can learn about grieving from the Day of the Dead.)

Practice radical acceptance

Much prescient grief comes from wishing things could be different and grieving that they are not. However, you can hold both thoughts at the same time, which allows you to accept the heartbreaking situation for exactly what it is while still acknowledging your feelings as valid, Nathanson says.

See a grief counselor

Grieving is a normal and expected part of life, but you may find yourself getting stuck in the process. Bereavement counselors are trained to help you deal with these complicated feelings and to support you through the process.

Be patient with yourself

Grief can be very painful, and you may want to speed up the process. Unfortunately, there’s no rush, and trying to force yourself to “get over it” can make healing even more difficult, says Nathanson.

During this time of expectation, be patient and gentle with yourself.

“Grief is not an illness. It’s not a sign that something went wrong. It’s actually a sign that something’s going well,” says Nathanson. “It’s a sign that you love her.”

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