The Unique Pain of Anticipatory Grief



We all thing of grief and mourning as the process that comes after a death.  But, there is an even longer mourning period that comes before the loved one’s death.  The grief process we go through leading up to a loved one’s death is usually referred to as Anticipatory Grief.

“Anticipatory grief refers to a feeling of grief occurring before an impending loss. Typically, the impending loss is the death of someone close due to illness.”

This early grieving period begins when we awakens to the reality of our own mortality or the mortality of a loved one.  It can be start with an event (a cancer diagnosis) or developmental milestone (e.g. turning 75).  But something happens and it kicks off a change in perspective. We go from focusing on all the life we have ahead of us, to realizing how little time there is left.  This shift from all the time in the world, to “how much time do I have left”, is the hallmark of anticipatory grief. 

Anticipatory grief can feel endless

For most of history, the space between becoming old and dying was brief, the time between getting ill and dying was even shorter.  But, with today’s medical interventions, it is not uncommon to receive a terminal diagnosis, and live on for years or even decades.  Trying new treatments, new clinical trials. You can get on a roller coaster of remission and relapse. Over and over. 

Anticipatory grief is often mistaken for depression

In my experience what many therapists see as depression is actually the impact of Anticipatory Grief.  While the symptoms may be similar to depression, their origin is very different.  

·        Crisis of Meaning: The individual is paralyzed by the question “did my life have any meaning”.  This can become a deep pit of spiritual loss.  This is especially true for those who have less than satisfactory lives – and carry many regrets or resentments over how their life turned out.

·        Detachment: As they feel that life is about to be snatched away from them, they detach from the people and activities in their life; as if to protect themselves from the coming loss.

·        Hopelessness: They know that death is inevitable, and nothing can be done to stop is arrival.  They feel like “sitting ducks” just waiting to be taken.

Rather than pathologizing these experiences as depression, a more constructive approach is to help the client find meaning  and discover hope. 

Aging is often the start of Anticipatory Grief

Aging is the most common start of anticipatory grief.  As people enter their “elder years” it is impossible to avoid the fact that death is a reality and moving closer. They hope for many more years, but they just can’t know.  And this reality is reinforced as friends and family die.  As they gradually come to accept the reality of their eventual death, they begin to experience anticipatory grief.  They look around at the people, places, excitement and beauty in their world, and realize that this will all be lost to them.  And with that realization they begin to feel the pain of loss. 

“Despair is the price one pays for self-awareness. Look deeply into life, and you'll always find despair.”

 ― Irvin D. Yalom, When Nietzsche Wept

Even survival can trigger anticipatory grief.  Paradoxically, while surviving a cancer or a heart attack can be very life affirming, it is also very death affirming. A “brush with death” makes very real the fragility of our existence and reminds us that we can be taken at any time. This realization of one’s own mortality can initiate a mourning of the “impending” death starting at any age.  Unfortunately for some, this death anxiety causes healthy individuals to start mourning their death decades before they die.

Lack of recognition of Anticipatory Grief

We all know that people have only a limited ability to support you in your grief.  People quickly begin to urge the griever to “move on” or “be brave” or even “get over it”. 

But, as little tolerance as they have for grief after death, they have virtually no tolerance for grief before death.  Unless they have had the experience themselves, they won’t be able to relate to some who is grieving before the loved one’s death.  In fact, they will criticize the griever for “giving up hope” and “focusing on the negative”.  And they will tell the griever to “enjoy him while he’s here” and the classic “be grateful for the time you have with her”. Completely missing the fact that this individual needs as much support in mourning the loss to come as they will in mourning the final event.

Giving support for Anticipatory Grief

As we watch ourselves and loved ones age, we feel the pain of the future loss.  As we take care of loved ones in their illness, we feel the pain of the future loss.  As we grapple with the idea of our own mortality, we feel the pain of the future loss. 

The answer is not to fight this awareness and pain, but to accept it as a part of life.  By feeling the pain of loss, we diminish the pain of loss.  By opening ourselves to the reality of loss we free ourselves from the pain of resisting the loss.  And by being willing to explore the meaning of life, we find greater meaning.

 


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