Introduction: Anticipatory Grief
Anticipation heightens the senses and enhances birthdays, holiday celebrations, vacations. Unfortunately, anticipation can also magnify the possibility or reality of a loss. As far as we know, we are the only species aware of the inevitability of our own death. Knowing that we and all of our loved ones will die someday creates anxiety. We see this early on in life.
In childhood we realize at some point that we will die, and not only will we die but those around us will die someday too. That is our beginning of anticipatory grief: fear of the unknown, the pain we will someday experience. It is present in most of our childhood stories and movies as if they were archetypally preparing us.
“Bambi’s mother was shot!” many little girls cried to their dads when the movie first came out. That was the moment when many of us in our generation realized someone we cared about could die. For our children, it is Simba’s dad dying in The Lion King. At an early age we momentarily anticipate that we can lose our parents. In our minds the thought is there, but denial helps us by telling us that it will happen to someone else’s parents, Bambi’s or Simba’s, never our own.
A deeper anticipatory grief occurs years later when someone we love—or we ourselves—have a terminal illness. Anticipatory grief is the “beginning of the end” in our minds. We now operate in two worlds, the safe world that we are used to and the unsafe world in which a loved one might die. We feel that sadness and the unconscious need to prepare our psyche.
Anticipatory grief is generally more silent than grief after a loss. We are often not as verbal. It’s a grief we keep to ourselves. We want little active intervention. There is little or no need for words; it is much more a feeling that can be comforted by the touch of a hand or silently sitting together. Most of the time in grief we are focused on the loss in the past, but in anticipatory grief we occupy ourselves with the loss ahead.
When a loved one has to undergo anticipatory grief in order to prepare for the final separation from this world, we have to go through it too. We may not realize it at the time. It may be a strange feeling in the pit of the stomach or an ache in the heart before the loved one dies. We think of the five stages of death occurring for the dying person, but many times loved ones go through them ahead of the death also. This is especially true in long, drawn-out illnesses. Even if you go through any or all of the five stages ahead of the death, you will still go through them again after the loss. Anticipatory grief has its own process; it takes its own time.
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Fred and his wife, Karen, had been retired for two years. They had taken a cruise and were enjoying the fruits of their labor. They had one grown son, John, now married. They were a very strong family but also a very stoic one. John’s wife would tease him and say, “Does anyone in your family have feelings, or do they just have opinions on events?”
Fred was feeling tired, and a medical workup found he had pancreatic cancer and less than a year to live. The family put together a plan and put all his affairs in order. John’s wife told her mother-in-law, “There is heaviness in the air. Why doesn’t anyone talk about it?” “We will deal with it when it is time,” her mother-in-law replied.
One Sunday, they were having a garage sale. John and his wife were over to help his parents. They’d had garage sales before, but there was noticeably more stuff this time. As Karen and her daughter-in-law were out in front selling, John went inside to see where his dad was. His father was aimlessly walking around the house. John asked, “Dad, are you okay?” His father replied, “I am not sure what to do.”
John felt sadness underneath and wanted to help his father. “Come outside and help,” he said. As they passed through the garage, his father stopped and looked at his workbench. His father had loved working in the garage fixing things. John and his father had recently had a talk about how John doesn’t really fix things like his dad and how the world has changed. “Things are so inexpensive and time so valuable,” John had said, “you don’t fix it, you buy a new one.”
Before leaving the garage, Fred stopped and surveyed his tools. John watched his father, wondering what was going on inside him. Fred then turned to John and said, “Will you bring all these tools out front to the garage sale?”
John said, “Dad, are you sure?”
“Yes,” he said and walked outside.
John began gathering the tools from the bench, the walls, and the drawers. He could picture each tool in his father’s hand when he was a child watching his father work away. John began feeling sad, and before long he was standing in the garage alone, sobbing.
His father walked in and put his arm around him and said, “For all of us, son. For all of us.”
Even the most stoic family is not immune to anticipatory grief. John was the son who expressed the feelings held within them all. He was demonstrating that we grieve after someone dies but we also grieve before.
Anticipating a loss is an important part of experiencing that loss. We often think of it as part of the process our loved ones go through as they face their own death themselves. Yet for those who will survive the loss of a loved one, it is the beginning of the grieving process. Such anticipation may help us brace ourselves for what is to come, but we should be aware that the anticipation of an event may be just as powerful as the event itself.
Forewarned is not always forearmed. Experiencing anticipatory grief may or may not make the grieving process easier or shorten it. It may bring only feelings of guilt that we were grieving before the loss actually occurred. We may experience all five stages of loss (denial, anger, bargaining, depression, and acceptance) before the actual death. We may experience only anger and denial. Not everyone experiences anticipatory grief, and if they do, certainly not in the same way.
We may also experience the limbo of loss in anticipatory grief, those times when our loved one is not getting better and not dying yet, but in a state of poor health with little quality of life. For those dying, it may be a time of quiet desperation or outright anger: those moments when our loved one can watch TV but is not able to change the channel, or they are hungry but unable to hold a spoon.
Loved ones witness and feel all those moments also at their own level. One person described the time in between as “not worse than death, but death or worse,” and their loved one was stuck in “worse.” The limbo of loss is in itself a loss to be mourned. Uncertainty can be an excruciating existence. It is the loss of life, going nowhere or going nowhere slowly without knowing if there will be a loss.
In cases with years to prepare for a death, we may not experience the stages after death. In long-term diseases like ALS, MS, or Alzheimer’s disease, we may be losing our loved ones so gradually that there is time to experience all five stages over a period of years.
In some cases, anticipatory grief may happen months or years before the loss. It is important for us to remember that this anticipatory grief stands alone from the grief we feel after a loss. For many, anticipatory grief is just a prelude to the painful process we face, a double grief that will ultimately bring healing.