The Doomsday Emotions of Impending Loss: Anticipatory Grief and Coping With Grief Before Death

04 Nov 2019 - Tracey Wallace

Welcome

Humans are great as storytelling and giving meaning to events. It’s what makes us the species we are. It is how our brains are wired.

And yet, it is the end of a story that so often determines how we feel about it. Let’s look at martyrdom as an example.

Martyrs creates on-going stories due to their tragic death after often a highlight moment or series of events in life.

The entire story of one of the world’s major religions would hold much less weight, arguably, if he wasn’t a martyr. Jesus would have never died for our sins (or would have done so at a very old age). Jesus would have never risen from the grave (or perhaps would have done so as an elderly man). The story of his sacrifice would be much less poignant if he had lived to 80.

Martyrdom is powerful because the ending propels the story forward into the minds and retellings of those who are left behind.

But logically, we know this doesn’t make sense.

The ending isn’t the most important part of the story.

The day-to-day details on someone’s life are the most important parts.

None of that stop our anticipatory grief from taking over, though. Whether you have a terminally ill family member of friend, a friend who just has a cold, a family member who is aging (but otherwise healthy), or someone is just late for dinner –– our minds predict the ending, and often choose the worst possible scenario.

“It’s like we’re trying to dress-rehearse tragedy so we can beat vulnerability to the punch,” says Brene Brown about those moments when we anticipate the worst-case scenario.

So, let’s unpack anticipatory grieving in all its forms, and talk through ways you can work through the anxiety and fear, and lean into the smaller moments, the moments of joy –– the moments that really matter.

What Is Anticipatory Grief?

Anticipatory grief is grief that is felt prior to the loss of someone you love, often due to a terminal illness or diagnosis, but that can be sparked by a variety of circumstances. Anticipatory grief can be as intense are other forms of grief, including both mental and physical symptoms and issues that cause a disruption in your normal life and schedule.

It is important to know that anticipatory grief is normal, especially when it is tied to a close family member or friend who will soon pass away.

This is our body and brain’s way of recognizing and preparing for the inevitable.

Fear and anxiety are often larger parts of anticipatory grief than conventional grief. In fact, the fear of being alone, of what life will be like without them, or who you will be without them can lead to extreme anxiety that then forms anticipatory grief.

According to VeryWellHealth: “A study of Swedish women who had lost a husband found that 40% of the women found the pre-loss stage more stressful than the post-loss stage,” proving that the anticipatory grief can often be the hardest part. It is our fear of the unknown that puts us in this place.

You aren’t crazy. Those fears are real, and valid.

Yes, it is normal for anticipatory grief to feel like a roller coaster ride of emotions. Here’s how to recognize if you are experiencing this type of grief.

Symptoms of Anticipatory Grief

Similar to grief that occurs after a loved one’s death, anticipatory grief has both mental and physical symptoms.

Here is what to look out for, either in yourself or a friend or family member.

Sadness.

We can’t control our lives, and we certainly can’t control the death of those we love. Illnesses take route. Tragedies occur. Things can change –– and they can change fast. You may be experiencing sadness about a whole variety of things: not being able to take that trip you were planning next summer, not being able to celebrate their 50% anniversary, not having them around for your wedding or to see your children grow up.

Those things are heartbreaking, and you are right to be sad about them.

The sadness during anticipatory grief is often around a loss of an expectation –– that they would be here, that you would pass first, that it wouldn’t happen this way.

The best thing you can do is feel those emotions, and talk about them with friends and family if you can. Recognize the situation for what it is, and let your mind and body accept a new reality, which begins with the slow release (often with tears) of the one you had built up.

Fear.

Fear is at the root of anticipatory anxiety. We don’t know what is on the other side of loss and grief until we are there –– and every single loss we experience is unique and different. We can’t pre-plan, or even imagine (and if we do, we imagine the worse!) what life will look like when that inevitable moment happens. When we are left there standing, without our person.

Fear is a healthy emotion. It helps guide us from dangerous activities, and the loss of a close relationship is our community-driven brains is indeed a dangerous activity. This fear is legitimate.

Similar to the sadness, you must feel it, let it exist, and talk about it when you can (with friends, family or with a therapist).

The feeling is not fun, but it is there for a reason: because you cannot imagine the world without this person you love so much. Perhaps even talking to your loved one about it will be helpful. Our memories are what we use to carry our loved ones with us even when they are alive and well. That will continue to be true when they are gone, and we can use legacy projects to build new memories of them even in their absence.

Loneliness.

There are two types of loneliness felt in anticipatory grief: 1) Fear of loneliness, and 2) present loneliness in your feelings.

Both of these can be better addressed by talking to friends or family, or attending grief support groups –– even if those groups are online.

Our social media culture already has so many of us feeling incredibly lonely as people post only the happiest parts of their lives.

But there are communities out there where grief is embraced as a normal and natural part of human emotions (because it is!) and where you can feel understood by those who are there, have been there, or are willing to compassionately listen.

Anxiety about the future.

Anxiety about the future is fueled by fear, as mentioned above. And it is completely normal and natural to feel. Change in general sparks anxiety in most of us, especially profound change like the death of a loved one.

Take deep breaths when the anxiety feels overwhelming.

Remember to talk to those around you about it. And to talk to yourself…

Guilt.

Depending on the situation, guilt may be incredibly overwhelming as you experience anticipatory grief. If your loved one cannot talk, or is not aware of what is happening, and you feel there is something you need to say to right some wrongs, or you have some guilt perhaps even at the thought of relief from a family caregiver role –– guilt can be the primary emotion you feel.

Guilt is not something you can logic away –– and it is not a healthy expression of grief. It will not go away with their death, and likely only intensify.

It is so incredibly important that you talk to friends or family, and ideally a trained professional you can help you understand the guilt you are feeling and give you tool to work through it.

For instance, writing a letter to your loved one apologizing, or working on self forgiveness techniques. There are a ton of exercises you can do, and with the help of a therapist, you can alleviate the feelings of guilt around a difficult loss.

Physical problems.

Physical ailments accompany grief because our mental health has a huge impact on our physical side effects. As your grief (anticipatory or not) intensifies, so too will physical issues like sleeplessness (or sleeping too much), headaches and migraines, muscle cramps, nausea, and more.

During this time, treat the ailments as you like, but remember to eat healthy and sleep well (8 hours or so a night).

Be kind to your body. Listen to it. And continue to let the emotional aspects of grief come as they will, feel those emotions deeply, and talk to folks about them.

Some people like to accompany therapy, for instance,with acupuncture to help with the physical ailments of grief. Massages, if you have the means, can be a great option as well.

Concern for how children or others will deal with the loss.

None of us are born not knowing how to deal with death. Children are not afraid of death so much as they are curious about it.

Similar to how when a child falls and they look to an adult for how they are supposed to feel (Was it a bad enough fall to cry? Are the adults freaking out?), the way you as the adult respond to the grief will give the child cues about how to respond themselves.

Answer their questions honestly about loss and grief and what will happen. If you don’t know the answer to some of their questions, tell them that. Death is a mystery to us all, and grief is its sidekick. None of us know the answers to all the questions, and children will be OK with that.

Coping with Anticipatory Grief

All right -– so you know that you are experiencing anticipatory grief, or that someone you love is. What can you do? Well, there are a variety of options. You can mix and match some of the ideas below, and choose what remedy feels right for you. This is about your personal self-care during the impending death of someone you love.

Amy McDonald, Owner and CEO, Under a Tree Health and Wellness Consulting

We have anticipatory grief all the time when we think about things to come and how we will feel, whether it is about the death of a loved one or another major life transition.

My advice is to practice mindfulness and every time we catch ourselves going out into the future with worry and speculation. Pause, take a deep breath, and pull into the moment. Check in with yourself and feel the moment, the sounds, smells, feelings, etc…whatever it takes to stop and be in that moment the loved one is still living.

It takes practice every day, every hour and, sometimes, every moment. It is the only way to not live out in the future worrying about when the person will pass, and how we will feel and missing the precious moments we have left with them. Simple words, challenging to remember but has powerful results.

Again, grief in all its forms is different for everybody. It’s important to know that your journey won’t look exactly like the journey of others, so be conscious about what is effective for you and depletes you even more.

Educate yourself about what to expect.

Maybe you’ve heard about the Stages of Grief in schools or from a family member or just online somewhere, and you are expecting to experience those. Think again. Elisabeth Kübler-Ross originally outlined the 5 Stages of Grief in her book On Death & Dying written earlier in her career.

Years later, on her deathbed, she made a major revision to that original text: that the 5 stages of grief are not linear. They aren’t stages at all, except for those who are facing their own death.

The 5 stages –– denial, anger, bargaining, depression, and acceptance –– apply, according to Kuber-Ross to those who are experiencing their own demise. For those who are in the grieving process of someone they love, however, grief is more cyclical and the stages are not linear.

Instead, grief comes in intensities, and will do so throughout the rest of your life. Grief carves out a place in your heart and mind, and it stays with you –– though joy lives there too as time goes on.

Some describe grief as a brick you carry in your pocket. At first, you know it is there and it is incredibly heavy. But over time, you become less aware that it is there, until one day, you reach down in your pocket and feel that brick and it all comes back. But you don’t want to get rid of that brick. No, because that brick is what you have left of the person you loved.

Talk to friends or family.

In a study done in 2019 by Amerispeak and WebMD, it was found that the #1 thing those who are grieving said was helpful was spending more time with friends and family.

Yes, there are periods of isolation with grief of any type, even anticipatory grief, but by and large, those who are grieving like to be surrounded by those they love.

It is even more helpful if the friends and family don’t skirt around the sadness and the loss. Instead, bring the person up and tell stories about them. Point out details of the day they would have loved.

Their presence is still so very much there because of the memories carried by those who loved them.

Join a support group.

Where friends and family might not be able to help is in understanding how you are feeling, but a support group can help. Grief groups are gatherings of people who are experiencing all types of grief from anticipatory to tragic and beyond, and there folks can talk freely, without any fear of stigma, about exactly how they are feeling.

Better yet, many of these groups are run by professionals who can help provide therapy or point you in the right direction of amazing resources to help with any particular issues.

Maybe they know great acupuncturists for grief. Or a fantastic metal band where many of the grief group attendees go to bang their heads out among a crowd.

There are so many different ways of grieving, and grief itself tears you open anyway –– letting in space for a newer identity. Many of these activities can lead you to new friends and communities.

Hire professional help and focus on your life.

With anticipatory grief in particular, hiring a death doula can be incredibly helpful.

Death doulas are trained on helping folks pass away in the way they want to – but also in helping family members manage the grief (including the anticipatory grief), the guilt, and the paperwork (because that’s necessary!).

Therapists are also amazing resources during this time.

Spend time together and create new memories.

Even though you cannot do anything about the current situation (it is what it is and it will be what it will be), you can figure out things to do with the person who is going to pass away –– especially if they are still lucid.

Maybe you play games of dice in the hospital or hospice. Or watch some of your favorite movies (or reality TV!) together. Maybe you share stories about your favorite memories, or ask about who they were before you knew them.

Options may be limited, but the experiences you bring to the table during this time aren’t just helpful for you, they are helpful for your loved one, too.

Maybe bring their favorite flowers in, or really nice bed sheets. The small details matter now, just as they do throughout life. Time may be short, but actions speak so loudly.

Be open and talk honestly to the person dying.

Time is running out –– yes –– but it is indeed still here. Use it to make your peace. Talk about what is bothering you. Learn what they want and how they are feeling.

Perhaps ask them, if they are interested, in writing you a letter that you can read in the future. This activity tends to be incredibly cathartic for them as well as for you after they die.

Or, just chat with them. Talk about your anticipatory grief. Ask if they’ve ever felt it (maybe this kind of anxiety runs in the family and they can offer help or advice!). Talk about what they are scared of, what you are scared of, and about the amazing relationship you’ve had.

Yes, these times are sad, but they do not have to be depressing. Sad moments and joyous ones can live side by side, breathing the same air.

Try holistic methods of coping.

There are so many new age and holistic ways of coping with anticipatory grief from meditation to art therapy, massage therapy and Qigong, music therapy to yoga.

So many of these techniques combine both mental and physical activities to give you brain and body some breathing room, to allow the emotions to process, and to give you a small break in what is otherwise a very difficult and heavy time.

Helping Your Loved One Adjust

Perhaps one of the best things you can do with your anticipatory grief is put it to action helping your loved one have a comfortable end-of-life.

Focus on their needs, and what might make things more comfortable for them. Work with the palliative care team, if necessary, to see what small joys and delights can be made possible for a high quality of life, especially through their end-of-life care.

Together, the two of you can work through the emotions of a difficult moment, but one that each of us will face. All the better if we aren’t alone.

Back to more articles