Grieving doesn’t have a specific timetable and can in fact begin before someone’s death. If you’ve ever found yourself feeling depressed or worried ahead of a loved one’s death, this is what’s called anticipatory grief.
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With this type of grief, people see their loved one’s health declining and begin to react. Feelings of depression, worry, and irritability start to set in. Friends and family members prepare themselves by imagining their loved one’s death. Unfortunately by looking to the near future, anticipatory grief can come in and bring with it strong emotions.
Curious about anticipatory grief or worried about how to manage your feelings? Learn more about what anticipatory grief is and how to get through it. You’ll learn the different phases of anticipatory grief and the emotions that go with it to help understand what is happening.
Tip: If you're experiencing anticipatory grief, it might help to know that you won't be alone throughout the post-loss process—if and when the time comes. You can count on the fact that our post-loss checklist is there to guide you through all of the steps you may need to take, from filing paperwork to finding grief support.
What is Anticipatory Grief?
Anticipatory grief is a mixture of grief and preparation. The loss has not happened yet, but the person grieving looks ahead to imagine what life could be like without their loved one.
This can happen with long-term illnesses like cancer or kidney disease. It is also common when a person is diagnosed with Alzheimer's disease. Each of these conditions can bring a person closer to death.
With anticipatory grief, it can be felt by both the griever and the dying individual. Both people may feel the pain for different reasons. By preparing for a loved one's death, friends and family can find active ways to cope with their anticipatory grief.
A dying person may feel very differently, however. They may experience sorrow or anger when acknowledging death straight on. When a person knows they are about to die, the emotions they feel can be overwhelming.
Sometimes, anticipatory grief can begin even when there is hope for recovery. A griever imagines the death of a loved one, even when death is uncertain. In this way, anticipatory grief can be the first step of exploration of what death may be like.
Many people may misunderstand anticipatory grief. Some believe grieving before the death of a loved one will lessen the amount of pain after death, however, these are separate processes. Going through anticipatory grief may not make the normal grief process any shorter or easier.
Stages of Anticipatory Grief
Anticipatory grief is described in four stages or phases according to the Cancer Care website. The National Cancer Institute also adds some additional signs to the list.
Many grief professionals agree that grief is unique to each individual and certain phases of grief are similar amongst many people. The distinction is that it can happen in any order and may overlap. However, it is important to note that there is no correct way to grieve.
Here are some descriptions of the feelings related to anticipatory grief.
When anticipatory grief settles in, the sadness can be overwhelming and hard to live with. Many people tend to hold out hope that their loved one will recover until the last minute. Depression can start when an individual lets go of the last shred of hope. As reality comes down, their emotions can weigh heavily.
In one way, a griever or loved one of the dying person finally accepts that their loved one will eventually die. Death cannot be escaped and there is no chance for recovery. This can be a difficult reality to face, especially if their loved one has fought the illness for so long.
By the other token, the dying person finally admits that the fight is over. Despite their best efforts, they won’t survive and are running out of time. Handling that particular emotion can bring about depression and other feelings.
2. Feeling a greater than usual concern for the dying person
When a griever accepts the eventual death of a loved one, it can stir up feelings of regret and concern.
The griever tends to worry more about things they did in the past to upset their loved one and casts meaning on things that may have no importance at this stage. For example, parents regret the times they were upset with their dying child. Adults feel bad about arguments they had with their dying parent, and so on.
The dying person becomes aware of how their death will affect others. They may feel their fears about death more strongly and become worried about friends and family they will leave behind.
3. Imagining the death of a loved one
When everyone has accepted the inevitability of death, they might start to wonder, what does it look like? And with that thought, a flood of emotions and images can come in. Both the dying person and their loved ones may think about the funeral, where it will take place, who will be there, and what people may say.
In particular, the dying person may be asked for input if they have not already provided some via a will or end-of-life planning document. When they get close to passing, they might even think about who will be there for their last breath.
However, for both parties, they will wonder what the final moments will bring. For everyone involved, saying goodbye becomes a priority.
4. Getting prepared for what happens after death
As with the totality of death, the encroaching thought of “what is going to happen to my soul once it departs” can become a priority for the person dying. At this point in time, their spirituality may guide their thoughts and anxieties regarding this moment.
But with these thoughts, they can also bring some unease about their deceased body becoming different from their living one. Thinking about their spirit, body, and memory can leave them distraught, as they come to terms with the fact that they will leave friends and family behind. They will no longer be on the mortal plane.
But the dying person is not alone in their feelings. “How will I move on without them?” This question can likely be on a family member’s mind when they are watching their loved one drift closer to death. The family member or friend might be thinking about future birthdays, vacations, holidays, and other important events without their loved one.
Of course, thoughts like, “life will not be the same without them” are common. Going to their favorite restaurants, doing their favorite activities, and even mealtime will never be the same.
This glimpse into the future can be very upsetting, but the griever knows death is inevitable. They spend time preparing for this new reality.
5. Increased irritability
Irritability is common when someone feels unsettled, as grief is a time of transition. A person may feel angry at the people around them and others may wonder why and not know how to handle it.
Anger is an energetic emotion, and some people find it easier to express than sadness and worry. Others feel better and cathartic when they raise their voice and snap at people around them.
Grief, in all forms, can leave a person feeling helpless. The temporary rush of energy can feel good for a moment but irritability makes it difficult to connect with others when they need it the most.
6. Anxiety and worry
Anxiety and worry are also common with anticipatory grief. A person's awareness of death can make them emotionally sensitive, and they may feel stressed by the little things.
When a person knows they are about to lose someone they love, everyday tasks can seem difficult. It’s natural, as they recognize that their foundation is about to be shaken, making everything seem uncertain.
A dying person may start feeling anxious about losing time with loved ones. They may worry about unfinished business and the future of their community. They may feel anxious about the loss of control and how their life ends.
Death changes a person’s personality and physical appearance
The appearance of a dying person can change as their illness gets worse. They may go through personality and mood changes. They might not notice, but these changes may become noticeable to others and confirm that death is near.
Family and friends can become saddened as they watch the transformation unfold. They know their loved one will never look, speak, or sound the same.
A dying person may or may not notice, as personality changes are harder for a person to notice in themselves. Memory loss and other mental changes can also make the person completely unaware of certain things.
Examples of Anticipatory Grief
Each of these stories describes a phase in anticipatory grief. The scenarios show how grief can be felt by an individual looking ahead at their loved one’s death.
Irritability - Paul has lost time with his mother
Pauline is a woman in her 90s with Alzheimer's disease and Osteoporosis. Her body and mind have begun breaking down rapidly. Her son Paul lives several states away and can only visit once a year.
He comes to visit and is shocked to find his mother’s health has declined. Paul feels agitated and antsy. Instead of enjoying his trip, he feels restless and frustrated. He is upset that he’s missed so much and his mother’s health has declined.
His anticipatory grief is felt as irritability. He is immensely sad that his mother has gotten so sick and might pass sooner than later.
Mourning the physical changes Kailyn is going through
Sarah is a 14-year-old girl whose friend, Kailyn, has been diagnosed with cancer in her bone marrow last year. Kaitlyn has undergone treatment, but the cancer has spread to her lungs. Things got very bad very quickly.
Sarah notices Kailyn is being strong for her friends, but Sarah senses Kailyn won't make it to the end of the school year. It's clear how weak and sick she has become. Sarah remembers how strong and energetic her friend used to be. She chats and laughs with Kailyn when she gets the chance. But Sarah always cries in private after spending time with her.
Her anticipatory grief is focused on the visible changes her young friend has gone through.
Imagining life after Dan’s death
Dan is a theater coach at a small high school. He was diagnosed with pancreatic cancer and retired early from his job. His family puts on an event to celebrate his retirement. Previous students came to tell jokes about their old coach and made everyone laugh.
Julie is one of his former students and has come back to her hometown for the event. She is happy to see Dan but is also overcome with grief. She knows this may be the last time she ever sees Dan.
Her anticipatory grief is imagining that this might be the last time she sees Dan and the thoughts and emotions weigh heavily on her.
Anticipatory Grief is Always A Unique Process
Anticipatory grief pushes the mind and heart to look beyond a loved one’s death. Grieving ahead of time does not change or reduce the grief that comes after death. Instead, it is a prelude and a preparation for loss.
If you or a loved one is overwhelmed by grief, consider contacting a counselor in your area for guidance. You can also join an online grief support group.
- “Anticipatory Grief: Preparing for a Loved One's End of Life.” Cancer Care, October 12, 2018, www.cancercare.org/publications/385-anticipatory_grief_preparing_for_a_loved_one_s_end_of_life
- “Grief, Bereavement, and Coping With Loss (PDQ)–Patient Version.” National Cancer Institute, March 6, 2013, www.cancer.gov/about-cancer/advanced-cancer/caregivers/planning/bereavement-pdq