What is anticipatory grief and how to cope with it
Summary
When we talk about anticipatory grief, we are referring to the emotional and relational process that some people experience in the face of a future loss, when it is known or perceived as inevitable. A significant loss can always be anticipated (such as an amputation, a change of residence, or retirement), although the term anticipatory grief is usually used in contexts of foreseeable death.
On the one hand, it can occur when a person suffers from a serious or advanced illness, where the medical prognosis is not promising or there is even an estimated life expectancy (for example, chronic degenerative diseases or when admitted to palliative care). In these cases, loved ones can begin to process some aspects of the loss before death occurs.
On the other hand, it can occur when a person disappears and their death is not confirmed. This would be the case in disappearances or major accidents where the victim count may be delayed. In both cases, there is some preparation prior to the final announcement of death.
Anticipatory grief responses gained interest in 1944 when psychiatrist Erich Lindemann analyzed the intense grief reactions experienced by women whose husbands were at the front. He was later followed by prominent theorists such as John Bowlby (analyzing the effect of a child's terminal diagnosis on their parents) and Elisabeth Kübler-Ross (supporting terminally ill patients and their families).
Various studies have established that the reactions of people experiencing anticipatory grief can be as intense as those experienced after a death . However, this process provides us with a window of opportunity to prepare for what comes next and ensure a healthier outcome.
When comparing both grieving processes, it is important to consider some factors:
- The acceptance time
There's a window of opportunity to come to terms with the situation, which isn't the case with unexpected deaths. This window allows for resolving unfinished business, choosing how to say goodbye, or organizing the time the deceased person has left. This can make the post-mortem grieving process healthier when the time comes. - Feelings
The emotions are the same in both processes. We may feel deep sadness, anger, anxiety, guilt, fear, loneliness, fatigue, lack of concentration, etc. Similarly, we may experience an initial shock, with feelings of disconnection, or we may deny reality as an avoidance reaction. - The previous reorganization
After a death, life changes and shifts in family roles occur. In the case we're discussing, certain situations can foreshadow what life will be like without that person: celebrations, trips, and so on. Similarly, one can begin to redefine the roles each person has within the family and their own identity without that person ("who am I without you"). - Pre-mortem exhaustion
If the situation persists for a long time, people may reach death itself emotionally exhausted. This sometimes results in less intense displays of grief after death . This doesn't mean there is less pain, but rather that they have been suffering for a long time and may experience a certain emotional numbness or numbness initially.
Aspects that complicate grief
To truly begin processing grief, one must accept that the person has died . This cannot be done until medical confirmation is received. We can accept other realities, but not death itself. Many people even need to see the body to connect with or confirm that the person has truly died. This is one of the reasons why wakes are held and why, in most cases, they are conducted with an open casket.
Although anticipatory grief is a normal process, it can interfere with our well-being and daily lives. The pain of the impending loss is compounded by witnessing the decline (and possible agony) of a loved one with the uncertainty of not knowing when it will happen. Despite being natural, the process by which our brain attempts to adapt to a new reality can be distressing. All our neural connections are configured with information about the loved one, and therefore, for a time, we will have to create new connections and memories in which that person is no longer present. This is painful and leads us through various psychological states.
In some cases, anticipatory grief, just as in post-mortem grief, can lead to less healthy psychological conditions that generate excessive discomfort, preventing us from continuing with our daily lives.
There are a number of signs that indicate the process may present some difficulty:
- Excessive worry with constant rumination (endless thought loops that generate a lot of anxiety).
- Paralyzing anxiety that makes it difficult to spend quality time with the loved one who will die.
- Depressive symptoms that cause us to isolate ourselves.
- A feeling of surrender, listlessness, and apathy that prevents one from enjoying anything in the time that remains.
In some cases, people give up, and some react by limiting care or abandoning the sick person because they cannot manage or cope with the situation and wish for the end to come as soon as possible (even if not consciously).
Taking care of yourself to manage the emotional impact of grief
Grief is an adaptive process , whether it occurs before or after death . This process is not harmless and, although natural, can cause significant pain and distress. Having professional or emotional support during these processes can lessen the pain and prevent complications.
The considerations for navigating this process in a healthy way are the same as those for post-mortem grief and include, among others:
- Give yourself permission to share your feelings (whatever they may be) in safe and trusting environments. Don't force it or explain everything to everyone; you need to be able to find spaces and people with whom you can express yourself confidently and securely. These should be spaces where you feel cared for. Talking about emotions, worries, feelings, and thoughts, without fear of judgment or the need for solutions, helps process the constant noise in your head.
- Prioritize basic self-care , such as eating, sleeping, socializing, and maintaining some physical activity. Our brain needs certain neurotransmitters (chemicals) to continue functioning normally, and we can encourage their release naturally.
- Consult a professional . Many medical or hospital services and units offer support during these processes. The goal is not to treat a condition, but to provide guidance and support so that the process progresses smoothly.
