How to deal with anticipatory grief
Anticipatory grief is the grief that arrives before a loss occurs. It is a real and normal response to an impending loss — not a lesser version of the grief that follows a death, but grief in its own right. Understanding how to deal with anticipatory grief begins with recognising it for what it is: an experience felt not only by the people who love someone who is ill, but often by the person who is ill themselves.
In this article I look at who experiences anticipatory grief, what it feels like emotionally and physically, why it so often goes unacknowledged, and how to deal with anticipatory grief in a way that is honest and grounded. I also cover when it may be worth seeking professional support.
Table of Contents
Grief before the loss
Anticipatory grief can be experienced as a range of feelings, including sadness, fear, anger, relief or emotional numbness.
Some defining features of anticipatory grief include:
Dual Experience
It can be experiences on both sides of a relationship.
A sick and dying person may grieve because they are mourning the loss of independence and the normal functioning of their mind and body.
A couple may mourn because an illness begins to rob them of their capacity for intimacy and quality time together.
Family and friends may mourn the fact that their loved one won’t be present to celebrate milestones such as births and graduations and weddings.
Layered Losses
Rather than simply being a precursor to death, it involves incremental losses such as the loss of a loved one's capacity or personality, as happens in dementia, or their capacity as happens with motor neurone disease and advanced cancer.
Symptom Mirroring
Anticipatory grief mirrors many of the emotional and physical experiences as those that follow death, such as shock, sadness, anxiety, helplessness, anger, and sleep disturbances.
Anticipatory grief isn’t confined to death and dying. It often shows up when a relationship is ending but hasn’t been finalised. I’ve witnessed this when counselling couples heading towards separation and divorce. They will often experience grief for their imagined future, the prospect of children and grandchildren, and growing old together. Explaining anticipatory grief as a normal and valid response to their life circumstances helps normalise their experience.
It’s also a natural response to major life transitions such as children leaving home, a career-ending and approaching retirement: circumstances where a relationship or life role is ending and grief arrives before the change is complete. Many people in these circumstances have no name for their experience or context for their feelings.
While anticipatory grief is often intensely painful, I’ve found that helping clients understand their feelings as a natural response brings comfort by helping them make sense of their circumstances.
What anticipatory grief feels like
Anticipatory grief affects all aspect of our being—out feelings, thoughts and physical being.
Emotional aspects of anticipatory grief
Anticipatory grief can be experienced as a range of feelings, including sadness, fear, anger, relief or withdrawal and Isolation.
Sadness
Feeling sad and tearful is a natural response to impending loss and bereavement. Clients reports that simply thinking about endings—of relationships and the people they love—bring intense waves of sorrow and distress.
Fear
People often worry about what life will be like after loss. Many people report feeling anxious and fearful about coping with finances, balancing home and work responsibilities, and future living arrangements on their own. These concerns and worries can harm quality of life, long before the person or situation has been lost.
Anger
Knowing that life circumstances and relationships are ending create frustration because we are powerless to change what’s coming. Without help or perspective, frustration can build to anger, which often feels powerful even though it masks our underlying feelings.
Guilt
Guilt is a common aspect of anticipatory grief because we want our suffering to end. We want this indeterminate agonising part of life to be over and feel selfish and guilty for wanting it. Also, we may feel guilty because we experience feelings of happiness and reprieve from our suffering.
Withdrawal and Isolation
When managing the challenges and feelings that come with anticipatory grief, you may find yourself isolating from friends and family. The activities and people that brought pleasure and comfort don’t feel so anymore. These experiences can lead you to believe no one understands what you are feeling or thinking, so you pull away, which often compounds suffering,
Cognitive aspects of anticipatory grief
Mental aspect of anticipatory grief can include persistent, intrusive thoughts or urges that cause distress. These thoughts and mental imaginings can grow and become overwhelming because we’re trying to change or solve a situation that’s insolvable. We suffer not only because we are grieving the end of a life and love we hold precocious but because our suffering seems never-ending and all-compelling to our minds.
Physical (somatic) aspects of anticipatory grief
Living with the experience of impending loss is traumatising. It puts our body’s nervous into high alert by activating our internal survival responses. We feel overwhelmed, flooded, stuck and trapped in our experience.
As this experience imprints itself on our nervous system repeatedly, we’re likely to become dysregulated—pushed out of our “window of tolerance” where we can function effectively.
This can affect our capacity for rational decision-making self-care. self-confidence, and trust in our capacity and resourcefulness to navigate life.
When we are pushed to the limits of our nervous system’s window of tolerance we have little capacity to withstand the normal stressors of living. In additions, factors such as a busy lifestyle, poor diet, lack of adequate sleep, and financial concerns can push us beyond our limits and cascade into emotional and physical overwhelm.
Why anticipatory grief often goes unacknowledged
Anticipatory grief is a complex emotional challenge because it exists in a cultural vacuum. Western society conditions us to view grief as a response to death—something that begins only after a pulse stops.
When we start mourning a person who’s still living, we clash with unspoken cultural rules, leaving both the dying person and their support network stranded in an ambiguous, lonely state of limbo.
The cultural silencing anticipatory grief
Our collective understanding of grief is anchored in denial and false positivity, so anticipatory grieving lacks societal "permission". This lack of consent shows itself in many ways:
The stigma of "giving up"
Culturally, we’re told to "fight" illness until the very end. So, beginning our grieving before the last breath can be misread as surrendering hope or showing disloyalty to the living person.
The isolation of the unnamed
When someone dies, there are rituals—funerals, casseroles, bereavement leave. Anticipatory grief doesn’t have these supporting rituals. Friends and loved ones feel they have to hide their pain because it’s difficult to tell others why we’re crying about someone who’s still with us.
The penalty of exhaustion
Friends and loved ones may feel they have to their own emotional needs because that they’ve no right to complain or fall apart while their loved one is facing their dying and death.
The shadow of guilt for supporters
Guilt is the most consistent thread woven through anticipatory grief. It pulls those supporting a dying person in many different directions.
Premature life building
Supporters often feel shame when they find themselves mentally planning for a future after the loss. Designing a life without a dying person while they’re alive feels like an act of betrayal, yet it’s often a necessary coping mechanism.
The shame of hoped-for relief
Watching a loved one deteriorate is traumatising. When a caregiver secretly hopes for the end to arrive quickly, it rarely stems from malevolence; it comes from a compassionate desire to see a loved one’s suffering end, and a real need for relief from their own round-the-clock exhaustion. However cultural assumptions often weaponise our desire for relief into guilt.
The double-edged loneliness of dying people
For a person who is dying, anticipatory grief can be a deeply isolating experience.
Grieving the former self
Before they even mourn the loss of their future, a sick and dying mourns the loss of who they used to be—their independence, their role in the family, and the physical capacities stolen by their diagnosis.
The burden of being the burden
A profound source of sorrow for a dying person is watching the emotional, physical, and financial toll their illness takes on their support network. They carry the heavy grief of "ruining" the lives of those they love most.
The ultimate paradox
The person who is ill must navigate the loneliness of being the literal focal point of everyone else's grief, while simultaneously holding their own sadness about the future they’ll never get to see. They’re surrounded by mourning people, yet entirely alone in their specific departure.
How to deal with anticipatory grief
Attending to one’s anticipatory grief is a profound act of mercy, whether we are facing our own death or supporting a loved one who is doing so.
Grief is an experience that comes alive in the body as a multitude of sensations before it registers in the mind.
So, our first act of mercy is to notice these sensations: where they’re felt in the body, their intensity, their particular nuances.
In clinical-language this is ‘somatic’ or body-based therapy. It means focusing our attention inward first and leaving the naming of our feelings and thoughts to later.
We all have an innate capacity for embodied awareness, meaning noticing what’s happening in the body’s felt sense of itself in the moment.
So, before engaging in too much head-talk, my first task after seeking some introductory context with a client is to establish a setting for embodied awareness.
This can start with a body scan. You could do this by sitting or lying in a position that feels safe and restful.
Closing your eyes might help avoid external distractions. Feel your body being supported and ask ‘what do I notice right now in my body? Take your time to scan slowly from head to toes with soft, curious attention.
Notice softness and hardness, pain and pleasure, and any other sensations that come to your attention.
As you do so, notice the depth and quality of your breathing. There’s no need to change anything. Just rest and notice all the sensations alive in and on the surface of the body.
As you do so, notice any emotions linked to these body-sensations. Is there sadness? Maybe fear? Anger? Joy? Shame? Something else that’s nameless?
As you notice these feelings, allow yourself to meet yourself with mercy. If you can, let yourself soften around any discomfort or resistance.
If you notice any judgements coming into your awareness, acknowledge them and let them be.
Let yourself just be with embodied awareness.
If there’s grief, where does it live in the body? Let yourself just be with your grief rather resisting or doing anything with it.
Sensing the body’s sensations and feelings is a native ability in all humans. Doing so is a way to come home to ourselves. It’s the first step on our innate path to self-regulation and healing.
Then ask yourself, “what in your life helps you feel more grounded or centred?”
Another helpful question is, “what in your life makes you feel the most like yourself?”
Your answers are your innate resources. Ways to notice and calm your nervous system rather than numbing or pushing through unpleasant sensations and emotions.
Another important aspect of responding to our grief—and any other feeling—is to share ourselves with those that have the capacity to listen deeply, without advising or fixing. This could be a therapist, a friend or a loved one.
This is a deeply loving way of sharing ourselves and our grief in the time we have remaining. It’s also a counter-cultural action: an act of presence and truth-telling in a death-phobic culture.
For those of us who are friends or family of someone who is dying, and who are burdened by grief, practising embodied awareness is an important way to meet our grief without judgment.
Asking ourselves these questions I posed above will help.
Then ask yourself, “what in your life helps you feel more grounded or centred?”
“What in your life makes you feel the most like yourself?”
Your answers to these questions are your guides to tending to yourself with awareness, compassion and mercy.
Looking for support with grief counselling in the Blue Mountains?
If you are living with anticipatory grief and would like support, I offer individual counselling in the Blue Mountains and via telehealth across Australia. You can find out more or book an appointment by clicking on the button below.