Anticipatory Grief: Grieving Before Death

Anticipatory grief, or grief that occurs before death, is common among people who are facing the eventual death of a loved one or their own death. Yet, while most people are familiar with the grief that occurs after a death (conventional grief), anticipatory grief is not often discussed. Because of this, some people find it socially unacceptable to express the deep pain they are experiencing and fail to receive the support they need. What is anticipatory grief, what symptoms might you expect, and how can you best cope at this difficult time?

As a quick note, this article is directed more to someone who is grieving the impending loss of a loved one, but preparatory grief is also experienced by the person who is dying. Hopefully, this article (as well as another on how to cope with anticipatory grief later on), will be helpful to both those who are dying and those who are grieving a loved one’s imminent death.

Anticipatory grief is defined as grief that occurs before death (or another great loss) in contrast to grief after death (conventional grief). Rather than death alone, this type of grief includes many losses, such as the loss of a companion, changing roles in the family, fear of financial changes, and the loss of dreams of what could be. Grief doesn’t occur in isolation, and often the experience of grief can bring to light memories of other episodes of grief in the past.

Anticipatory Grief Can Differ From Grief After Death

Anticipatory grief can be similar to grief after death but is also unique in many ways. Grief before death often involves more anger, more loss of emotional control, and atypical grief responses. This may be related to the difficult place—the "in-between place" people find themselves in when a loved one is dying. One woman remarked that she felt so mixed up inside because she felt she kept failing in her attempt to find that tender balance between holding on to hope and letting go.

Not everyone experiences anticipatory grief, and it is not good or bad to do so. Some people experience very little grief while a loved one is dying, and in fact, find they don't allow themselves to grieve because it might be construed as giving up hope. Yet for some people, the grief before the actual loss is even more severe.

Grief before death isn’t a substitute for grief later on, and won’t necessarily shorten the grieving process after death occurs. There is not a fixed amount of grief that a person experiences with the loss of a loved one. And even if your loved one’s health has been declining for a long time, nothing can really prepare you for the actual death.

Yet, while anticipatory grieving isn’t a substitute or even a head-start for later grieving, grieving before death does provide opportunities for closure that people who lose loved ones suddenly never have.

For those who are dying, anticipatory grief provides an opportunity for personal growth at the end of life, a way to find meaning and closure. For families, this period is also an opportunity to find closure, to reconcile differences, and to give and grant forgiveness. For both, it is a chance to say goodbye. The night my grandmother died I was lying in bed with her. She turned to me and said, "we’ll miss each other," and hugged me. It was her goodbye gift.

We receive emails often asking how we feel about a family member visiting a dying loved one. The comments we hear are, "I want to remember my loved one the way they were before cancer," or "I don’t think I can handle the grief of visiting." But anticipatory grief in this setting can be healing.

Though anticipatory grief doesn’t necessarily make the grieving process easier, in some cases it can make death seem more natural. It’s hard to let our loved ones go. Seeing them when they are weak and failing and tired makes it maybe just a tiny bit easier to say, "it’s okay for you to move on to the next place."

The emotions that accompany anticipatory grief are similar to those which occur after a loss but can be even more like a roller coaster at times. Some days may be really hard. Other days you may not experience grief at all. Listed are some of the typical emotions associated with anticipatory grief. That said, keep in mind that everyone grieves differently.

• Sadness and tearfulness: Sadness and tears tend to rise rapidly and often when you least expect. Even small things, such as a television commercial may be a sudden and painful reminder your loved one is dying; almost as if it is again the first time you are aware of your impending loss.
• Fear: Feelings of fear are common and include not only the fear of death but fear about all of the changes that will be associated with losing your loved one.
• Irritability and anger: You may experience anger yourself, but it can also be difficult coping with a dying loved one’s anger.
• Loneliness:  A sense of intense loneliness is often experienced by the close family caregivers of someone dying from cancer. Unlike grief after a loss, the feeling that it’s not socially acceptable to express anticipatory grief can add to feelings of isolation.
• A desire to talk: Loneliness can result in a strong desire to talk to someone—anyone—who might understand how you feel and listen without judgment. If you don’t have a safe place to express your grief, these emotions can lead to social withdrawal or emotional numbness to protect the pain in your heart.
• Anxiety: When you are caring for a loved one who is dying, it’s like living in a state of heightened anxiety all of the time. Anxiety, in turn, can cause physical symptoms such as tremulousness, palpitations, and shaking.
• Guilt: For some people, the time prior to a loved one's death can be a time of great guilt—especially if your loved one is suffering. At the same time that you long for your loved one to be free of pain (and hence, die), you fear the moment that death will actually happen. You may also be experiencing survivor guilt, a guilt that you will be able to continue on with your life while someone else will not.
• Intense concern for the person dying: You may find yourself extremely concerned about your loved one, and this concern can revolve around emotional, physical, or spiritual issues.
• Rehearsal of the death: You may find yourself visualizing what it will be like to have your loved one gone. Or if you are dying, visualizing how your loved ones will carry on after your death. Many people feel guilty about these thoughts, but they are very normal and are part of accepting the inevitability of death.
• Physical problems: Physical problems such as sleep difficulty and memory problems. Learn more about the physical toll of grief.
• Fears of loss, compassion, and concern for children: One study found that fears about what was going to happen and how they would be cared for were very strong in children who are facing the death of a parent or grandparent.

While you may have heard of the stages of grief and the four tasks of grieving, it's important to note that most people do not neatly follow these steps one by one and find that they wake up one morning feeling they have accepted what has happened and have recovered. Instead, any of these stages may be present at any one time and you may find yourself re-experiencing the same feelings of shock, questioning, or despair many times over. As noted above, there is no right way to feel or grieve. 

Anticipatory grief is a normal process in the continuum of grief. But in some cases, this grief can be so intense that it interferes with your ability to cope. It’s also common for people to develop depression when faced with all of the losses surrounding grief and it can be difficult to distinguish grief from depression.

It’s important to express your pain and let yourself grieve. Finding a friend or another loved one you can share your feelings openly with is extremely helpful, just as maintaining hope and preparing for death at the same time is difficult. It can be even harder as people may wonder why you are grieving—even become angry that you are grieving—before the actual death. Keep in mind that letting go doesn’t mean you have to stop loving your loved one—even after they die. During this stage, some people begin to find a safe place in their heart to hold memories of their loved one that will never die.