Grief Before Death

Mental health affects every aspect of our lives. It is a part of human existence that controls our emotions, thoughts, relationships, and actions, even if we do not notice it. Despite this, there is a strong stigma surrounding the topic that often makes others feel they can not reach out to anyone, even family members or friends, for fear that they will seem weak. In retaliation to this sentiment, the United States Congress designated May as Mental Health Awareness Month! As we observe this annual holiday it is very important to acknowledge a wide range of illnesses and how they affect others lives.

Amongst the great variety of human emotions, grief tends to have a distinct role in our society. It often accompanies us during hardships such as a divorce, the death of a family member, or the loss of a home. Despite this, a lesser-known form of grief happens before a loss. This form of grief is often called preparatory grief, also known as anticipatory grief.

What is Anticipatory Grief?

Anticipatory grief is a form of mourning that occurs when someone starts expecting a loss. It can be triggered by numerous situations such as a cancer diagnosis, realizing that your friends are getting older, and even imagining what life might be like without your pet. However, it is more commonly seen in the surrounding community of someone who is living in Hospice, a specialized form of health care designed to support those who are terminally ill.

There are many similarities between anticipatory grief and bereavement, the form of grief that happens after death. According to Bisma Anwar, a licensed mental health counselor and main writer of the article, Anticipatory Grief: Signs, Causes, & Coping Tips, “Anticipatory grief is similar to regular grief in a few ways.” she says. “Both invoke similar kinds of emotions but anticipatory grief can cause more emotional instability. This is usually because there might be times when a person feels more sad or alternatively more hopeful about not losing the person. Both types of grief can be coped with through therapeutic interventions.”

Fear: It is very common for this form of grief to stem from fear of when someone will die, how it would happen, and how life would change without that person there.

Guilt: Many people may experience intense guilt when watching a loved one die. For example, it is very common for people in this situation to feel at fault due to their life continuing while their loved ones’ life is ending. This is a common feeling amongst those experiencing grief called survivors guilt.

Health Problems: Anticipatory grief often affects someone’s body, not just their mind. Many people experiencing this form of grief could experience memory problems, sleep deficiency, gastrointestinal issues, changes in eating patterns, and inflammation. Additionally, grief causes body strain such as tooth pain, chest pain, headaches, and/or backaches.

Overthinking: It is common for thoughts related to the loss to preoccupy a person’s mind. This can result in feelings of worry, absence, and difficulty focusing on daily tasks.

Shifts in relationships: Anticipatory grief can often change the relationships of the person grieving. It is common for someone to start to prioritize the relationship of the person who is dying, pushing others away in the process.

Stages of Anticipatory Grief

Despite falling under the same category of grief, bereavement, and preparatory grief have very unique processes that are distinct from each other. Additionally, it is very important to remember that experiencing this form of grief is different for each individual. Many might experience the timeline in sequence order, others may move back and forth between stages, while others may only experience a few of the stages through their time of mourning. After many studies, The University of Rochester Medical Center introduced the stages of anticipatory grief as follows:

Stage One: Realization
According to URMC, this stage is where the grieving individual realizes that death has no cure. This stage is known for its occurrence of sadness and depression.

Stage Two: Concern
In this phase, individuals feel concerned for the person that is dying. It is in this stage that many start to feel regret; whether it be about past arguments or declining their requests. On the other hand, the person dying may feel concerned about their own death coupled with the negative emotions that family members may feel.

Stage Three: Rehearsal
According to The University of Rochester Medical Center, “In this phase, the actual death may be “rehearsed.” The physical process of death and what may happen after death are concerns in this phase.” At this stage, rehearsals can range from saying goodbye to loved ones to arranging a funeral for the person who may be dying.

Stage Four: Imagining
In the final stage, those grieving might spend time imagining what their lives would be like without their loved one that is dying. Siblings might think about how empty their room would be without their dying brother or sister, parents might think about their child’s prized possessions that they are leaving behind, and friends might think about how many birthdays they will have without the person who is dying.

How do you cope with Anticipatory Grief?

Similar to any other form of grief, anticipatory grief can be very emotionally draining. Thankfully, many strategies could help navigate through this condition. According to Merritt Whitley, a copywriter at A Place for Mom, a world-renowned online platform with a nationwide network of 17,000 providers who work towards making senior living referral services easier, provides numerous ways to cope with preparatory grief:

Acknowledge, Validate, and Express Emotions
The first step to healing is acknowledging and validating your emotions. Anticipatory grief is a natural response to losing someone you love. Try not to bottle these emotions within you, allow yourself to experience them and find an outlet for them. You can express your feelings by venting to a trusted loved one, praying, meditating, journaling, or visualizing your feelings using art.

Practice Forgiveness
Letting yourself forgive during anticipatory grief is a very important part of the healing process. Letting go of grudges, negative emotions, and any resentments can be a very relieving process that can make you feel liberated as a result. Forgiveness does not mean accepting or excusing the pain that someone caused you, rather, it is the conscious choice of letting go of the bitterness that has come from it. By letting yourself forgive you can free yourself from any previous emotional baggage and instead, find inner peace. This sentiment is represented in the article, Anticipatory Grief: Learning the Signs and How to Cope, by Merritt Whitley:
“Sometimes a dying person hangs on because of a feeling that others aren’t ready to let them go. Giving them permission to die, which means letting them know that you will carry on, can bring a profound sense of relief to both of you.”

Spend Quality Time with Loved Ones
During any type of mourning, spending time with friends and family members is very significant to not only your mental health, but your relationships. Spending time with loved ones can help build bonds, strengthen relationships, and show support for each other. Engaging in activities together such as looking at old photographs, going on a walk, cooking together, and listening to music may seem simple, but can build moments of togetherness that the both of you might even look back on after your loved one dies.

Although Mental Health Awareness Month has passed, it is important to remember that mental health and anticipatory grief affects a majority of people every day throughout the year. By acknowledging the challenges that come with mental health and spreading awareness about overlooked disorders, we can help individuals not feel ashamed to reach out for help, instead, we can help them feel seen, heard, and strong for taking a step in the right direction.

Resources:
https://www.verywellhealth.com/understanding-anticipatory-grief-and-symptoms-2248855#toc-treatment-and-counseling
https://samaritannj.org/hospice-blog-and-events/hospice-palliative-care-blog/what-is-anticipatory-grief/#:~:text=Anticipatory%20Grief%3A%20a%20Definition,loss%20of%20abilities%20or%20independence.
https://www.talkspace.com/blog/anticipatory-grief/
https://www.claritychi.com/grief-before-death-understanding-anticipatory-grief/
https://www.aplaceformom.com/caregiver-resources/articles/anticipatory-grief
https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P03043