Anticipatory Grief: What is It?

Anticipatory grief is a process that terminally ill patients often go through, as well as their family and friends.

The death of a loved one can give way to painful emotions of variable duration. The length of time depends on many circumstances. For example, the importance of the loss, the support network that the person has, the value of their daily reinforcers, or the substitution strategies that they have in place. Usually, it’s an event that occurs suddenly, removing the person from reality in some way. However, what’s the experience like for those who anticipate the physical loss of someone they love? In this case, they’re said to experience anticipatory grief, because they already know that death is going to occur.

Experts usually agree that this process is beneficial for the relatives of the deceased. Nevertheless, it’s important to remember that experiences of grief are different for each person. Furthermore, other factors, such as previous grief and certain personality traits, can make grief more or less painful.

Anticipatory grief

Some diseases, such as cancer or Alzheimer’s, are characterized by causing progressive deterioration in patients. When the condition is very advanced and there’s no intervention that’s capable of offering a chance of recovery, doctors usually estimate the time the patients have left. For both the patient and their loved ones, this event can be a trigger for grief.

In this sense, we speak of anticipatory grief when people begin to process what their lives will be like when the anticipated death occurs. In other words, it’s nothing more than grief that’s lived in advance.

Although they may be similar, ordinary grief isn’t identical to anticipatory grief. In fact, the latter has its own characteristics, and researchers have studied it for years. As a matter of fact, Aldrich (1974) explains that anticipatory grief differs from actual grief in five ways:

• It’s experienced by both the patient and their family and friends.
• It can’t be prolonged indefinitely since, at some point, the patient will die.
• Unlike actual grief, this kind intensifies as time passes.
• Denial tends to appear more easily.
• It’s possible that a phase of ‘hope’ occurs. This happens when the patient or their relatives anticipate recovery, despite the diagnosis.

Can anticipated grief be positive for emotional balance?

Anticipatory grief is often viewed as a positive process for those who expect a loss in the future. Majid and Akande (2021) published a review on this type of grief in relatives and partners of terminal patients. According to their research, those who grieve in advance tend to experience a better state of mind than those who don’t anticipate a future loss.

Similarly, Rogalla (2020) presented a study on the positive experiences of preparing for a loss. In her conclusions, she pointed out that those who anticipate the death of a loved one and actively deal with it show greater personal growth. This is because they see death as a challenge to overcome, and not as a psychological threat.

On the other hand, it’s said that early grief can be beneficial for family relationships. For example, terminally ill patients often decide to heal their bonds when faced with the threat of death. Consequently, it’s considered that anticipatory grief can ‘soften’ the impact of the ultimate loss.

However, it should be clarified that this isn’t always the case. For instance, some people may experience depressive episodes that make grief more difficult. In addition, it could complicate the palliative care that terminally ill patients often need.

Stages of anticipated grief

To date, there are some discrepancies regarding the definition of anticipatory grief and its characteristics. For this reason, it hasn’t been possible to define with any great precision the stages that characterize it. Here, we focus on the stages that Majid and Akande described in their work.

1. Discovery of future loss

This is the first stage and takes place when the patient and their loved ones receive the news of the diagnosis. During it, feelings of anger, frustration, devastation, confusion, and hopelessness may appear. There are also changes in the projects and activities of both the affected person and their relatives.

It’s common for family, friends, and partners to want to spend time with the patient. That’s because they become aware that this person isn’t going to be around for much longer. On the other hand, there’s the possibility of denial and feelings of anger towards oneself or the sick person.

2. Transition to hospital care

In this phase, the ill person tends to feel like they’ve lost their home because they now need permanent medical care. As a matter of fact, it’s more about the loss of the home routine that they used to have before the illness occurred. However, over time, a sense of familiarity with the hospital staff may develop.

At this moment of anticipatory grief, the responsibilities of care pass to the professionals. As a result, carers and relatives may experience a sense of relief from being released from many burdens. It’s also normal for the patient and their loved ones to arrange a final home visit since they won’t be returning.

3. Approach of death

As the estimated date of death approaches, a number of changes can occur in the patient and loved ones. On the one hand, the former usually develops avoidance behaviors towards the family. For example, they decide not to be present for a birthday or dinner. This is said to be a way in which they begin to adjust to the reality of death.

On the other hand, family, partners, and friends experience different emotions before the changes. The most common is anxiety caused by ambiguity and uncertainty about the future. At these times, different strategies are used, such as remembering that the death of the loved one is something out of their control. Or, the acceptance that absence is something that always happens sooner or later.

4. Death

The final stage of anticipatory grief tends to bring back all the emotions associated with the earlier phases. Then, anxiety about the future appears along with fear of loneliness, sadness, etc. To deal with their feelings, people often remember moments of their shared life history with their loved ones.

Some patients may request that they be allowed to die in the family environment. Another factor that influences the impact of death is the possibility of being able to be with the patient in their last moments. Those who can’t do it, regardless of the reason, often experience remorse.

How to handle anticipatory grief in a healthy way

There’s no manual to tell us how to handle these types of situations in a painless way. As a matter of fact, pain is an inevitable part of any grieving process. Furthermore, it’s best to accept emotions as they appear so that they can be processed.

The support of friends and other loved ones can help mitigate the impact of future loss. However, if intense depressive feelings appear that incapacitate the person, it’s best to seek professional help from a psychologist or psychotherapist. With psychological help, it’s possible to develop resources to help deal with the pain.

Finally, it’s relevant to mention that anticipatory grief isn’t limited to terminal patients. Families of missing persons can also experience a similar process when considering the possibility that a loved one has passed away.