Why Anticipatory Grief Is Different—and How to Deal with It
Mourning a loss that is expected but hasn't happened yet can be uniquely challenging. Here's how to identify and deal with anticipatory grief.
Sadness for what is coming
“My grief feels like dread,” says Anna Raway, 38, of Lakeville, Minnesota. Over the past several years she’s had to watch as her beloved mother disappears into the haze of Alzheimer’s disease.
There is some grief over what is happening now. Her normally patient and loving mom has started having angry outbursts.
“She would say and do things that hurt my feelings, and I didn’t know how to handle it,” Raway says. “Also, she can’t remember lots of things and that also hurts because nobody wants to see their parents struggling like that. I’ve cried a lot.”
But there’s another element to her grief, one that she has struggled to identify: a feeling of heavy sadness for not just what is happening now but for what she knows is inevitably coming.
“Every time I call or visit I worry that she won’t remember me or my family, that she’ll feel lonely because she’s forgotten we’ve visited, and I mostly just hate to see her suffer in confusion, because I know it’s only going to get worse until…” she says.
Alzheimer’s disease lasts until death.
What is anticipatory grief?
How do you mourn someone who hasn’t died yet but will soon?
There’s a name for the confusing, frustrating, scary feeling that Raway is describing—and it’s far more common than you may think, says Gail Trauco, a certified oncology nurse and licensed grief mediator who’s helped hundreds of patients and their families navigate this painful process.
Anticipatory grief is the process of grieving an expected future tragic event, often the death of a loved one from a terminal illness, explains Ashwini Lal, lead clinical psychologist at the Kaiser Permanente Bernard J. Tyson School of Medicine.
“It’s uniquely painful in [that] that which is being grieved still exists,” he says.
The grief comes from the anticipation of the loss, not from the loss itself, and that can be confusing, says Abigail Nathanson, a licensed social worker board-certified in palliative care, and professor of grief and trauma at New York University.
She adds that there are other ways to feel anticipatory grief. For instance, a senior graduating from high school may experience a form of “senioritis” that is grieving the upcoming unofficial end of childhood and transition to adulthood.
(Here’s how one young woman is dealing with anticipatory grief and loss after losing her husband to brain cancer.)
Signs of anticipatory grief
All grief is mourning some type of loss, and the process of grieving—while different for every person—generally follows a similar pattern. There are many different models for grief but broadly speaking, people can expect to experience denial, anger, bargaining, depression, and acceptance.
Grieving in general is not as simple as it may sound and when you add in the anticipation of grief it can feel even more complicated, says Nathanson. People suffering from this type of grief often have increased feelings of guilt.
“You may beat yourself up and think, ‘I should be enjoying the time I have left with them.’ You may even feel like your grief is ‘giving up’ on your loved one,” says Nathanson. “There can be a lot of self-judgment in anticipatory grief.”
This type of grief also comes with some uniquely difficult circumstances, says Trauco.
There are the practical aspects of knowing someone will die that must be taken care of, like end-of-life planning, final wishes, disposition of property, and physical adjustments. This can cause anxiety and stress, and it’s not uncommon to see an increase in family conflict during this time—all of which can intensify anticipatory grief, she says.
Symptoms of anticipatory grief
Though some of the reactions in the grief process will be similar to general grief, anticipatory grief tends to include a greater risk of depression and anxiety, a heightened concern for the dying person, and attempts to adjust to the expected consequences of the death, says Lal.
Due to the stressful and sometimes extended nature of this type of grief, you may experience some physical symptoms associated with chronic stress, including stomach problems, over- or under-eating, an increase in addictive behaviors, chest pain, and alcohol abuse, says Trauco.
Coping with anticipatory grief
“The goal of grief is not ‘How do I stop being sad?’ but ‘How do I carry this and still live my life in a meaningful way?” says Nathanson.
There is no one “right” way to grieve, nor is there a prescription for getting through it. But there are some things that many people find helpful during the process, she says.
The first step to dealing with this type of grief is being able to identify it for what it is, says Nathanson.
Knowing that you are grieving the anticipated loss can help you recognize the source of your feelings and understand them rather than trying to push them away or telling yourself you “shouldn’t” feel that way.
Feeling bad about your negative feelings will only make you feel worse. Identifying your feelings and the cause can help you work through them.
Allow yourself to feel it without judging it
“Understand that there’s no quota for grief—grieving now doesn’t mean you’ll grieve less later,” says Nathanson.
You may find yourself feeling guilt or discomfort with the notion of grieving someone who is still alive. But your experience is legitimate, and it is important to acknowledge your grief feelings, says Lal, adding that feeling relief after someone dies is also normal.
Talk about it
One of the best ways to deal with any type of grief is to talk about it with others who understand, says Lal. Oftentimes that will be others who are close to the person you’re feeling anticipatory grief for, but sometimes not always.
Friends more removed from the situation, hospice counselors, and/or members of support groups are all great people with whom to talk about your grief. Raway says she’s found an immense amount of comfort in sharing her feelings with others.
Plan meaningful activities
Depending on the situation—for example, how sick your loved one is—plan activities you can do together to make some good memories during this time, says Lal.
This could include things like playing a favorite game, taking lots of pictures, going on an adventure, keeping a journal, and making video recordings together.
This kind of mourning also offers some singular benefits, says Trauco.
“Anticipatory grief can be helpful in some ways because it motivates you to prepare for the loss, gives you time to say goodbye, and can lead to peace and a feeling of resolution and acceptance,” she says.
Take care of yourself
Eat a nutritious meal, take a walk outside, get plenty of sleep, and take a hot bath. All of the self-care tasks that were nice before will become necessities when you’re grieving, says Trauco.
(You may also find comfort in quotes about pain and how to deal with it.)
Put it in perspective
Birth and death are the universal experiences of this life, and so each person needs to find a framework for dealing with these big issues.
Many people find this perspective and meaning in religion or spirituality, but the important thing is to find what feels right to you, says Lal.
Cultural or religious traditions can help in this regard. (Here’s what you can learn about grieving from the Day of the Dead.)
Practice radical acceptance
A lot of anticipatory grief stems from wishing that things could be different and grieving the fact that they aren’t. However, you can hold both thoughts at the same time, allowing you to accept the heartbreaking situation for exactly what it is while still acknowledging your feelings as valid, says Nathanson.
See a grief counselor
Grieving is a normal and expected part of life but you may find yourself getting stuck in the process. Grief counselors are trained to help you navigate these complicated feelings and support you through the process.
Be patient with yourself
Grief can be intensely painful, and you may want to hurry the process along. Unfortunately, there’s no rushing it, and trying to force yourself to be “over it” can make healing even harder, says Nathanson.
Be patient and gentle with yourself during this time of anticipation.
“Grief isn’t an illness. It’s not a sign something went wrong. It’s actually a sign something is going right,” Nathanson says. “It’s a sign that you love them.”
- Abigail Nathanson, DSW, licensed social worker board-certified in palliative care, and professor of grief and trauma at New York University
- Gail Trauco, RN, BSN-OCN, a certified oncology nurse, licensed grief mediator, and author of Conquering Grief From Your Own Front Porch
- Ashwini Lal, PsyD, lead clinical psychologist at the Kaiser Permanente Bernard J. Tyson School of Medicine