Anticipatory grief refers to a feeling of grief occurring before an impending loss. Typically, the impending loss is the death of someone close due to illness. This can be experienced by dying individuals themselves [1] and can also be felt due to non-death-related losses like a pending divorce, company downsizing, or war.
The five stages model of grief – denial, anger, bargaining, depression, and acceptance, as proposed by Elisabeth Kübler-Ross – describes the process people undergo after learning of their own diagnosis of terminal illness. Anxiety, dread, guilt, helplessness, hopelessness, and feelings of being overwhelmed are also common. However, anticipatory grief is not simply normal grief begun earlier. [1]
Features identified specifically with anticipatory grief include heightened concern for the dying person, rehearsal of the death and attempts to adjust to the consequences of the death. The period can allow people to resolve issues with the dying person and to say goodbye. [1] It may provide some sense of orientation and access to the grieving process. For some, it prompts conscious closure before the end/loss. [2]
Grief happening prior to a loss presents a compounding issue of isolation because of a lack of social acceptance. Anticipatory grief does not usually take the place of post-loss grief: there is not a fixed amount of grief to be experienced, so grief experienced before the loss does not necessarily reduce grief after the death. [1] However, there may be little grieving after the loss due to anticipatory grief. [3]
How often anticipatory grief occurs is a subject of some controversy. For example, a study of widows found that they stayed with their husbands until the death and could only mourn once the death had occurred. Researchers suggest that to start to grieve as though the loss has already happened can leave the bereaved feeling guilt for partially abandoning the patient. [1]
Many family members can find themselves in a caregiving role during their loved one's process of death. During the progression of the illness, the security and protectiveness of the caregiver also increases. Bouchal, Rallison and Sinclair discuss that, "the strong need to offer protection was part of the anticipatory mourning experience of striving to be with in the present". [4]
In the process of anticipatory grief, family members also begin to prepare and reflect on how their lives will be once their loved one passes. There are many ways in which to perform reflection. These ways include: "...reading, journaling, thinking, and reflecting about how life might be like without their partner." The journal also expands on the premise that the preparation process is not an individual process. Those who are affected by the impending death often look towards one another for support as well as others who are involved in care such as nurses and social workers. [4]
A direct correlation exists between anticipatory grieving and the caregiver's quality of life. In a quantitative study conducted by Al-Gamal and Long, the effect of a pediatric cancer diagnosis on parents had a negative impact on the majority of study participants. More specifically, parents reported experiencing increasing stress and a decrease in physical and mental health – all of which affect the process of anticipatory grief. [5]
Ultimately, anticipatory grieving is an extremely dynamic process that differs between individuals. The outcomes of the grieving process depend on the preparation of death and the anticipatory grief process.
Mourning is the emotional expression in response to a major life event causing grief, especially loss. It typically occurs as a result of someone's death, especially a loved one.
Dying is the final stage of life which will eventually lead to death. Diagnosing dying is a complex process of clinical decision-making, and most practice checklists facilitating this diagnosis are based on cancer diagnoses.
Grief is the response to the loss of something deemed important, particularly to the death of a person or other living thing to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, grief also has physical, cognitive, behavioral, social, cultural, spiritual and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, while grief is the reaction to that loss.
Terminal illness or end-stage disease is a disease that cannot be cured or adequately treated and is expected to result in the death of the patient. This term is more commonly used for progressive diseases such as cancer, dementia, advanced heart disease, and for HIV/AIDS, or long COVID in bad cases, rather than for injury. In popular use, it indicates a disease that will progress until death with near absolute certainty, regardless of treatment. A patient who has such an illness may be referred to as a terminal patient, terminally ill or simply as being terminal. There is no standardized life expectancy for a patient to be considered terminal, although it is generally months or less. An illness which is lifelong but not fatal is called a chronic condition.
According to the model of the five stages of grief, or the Kübler-Ross model, those experiencing sudden grief following an abrupt realization (shock) go through five emotions: denial, anger, bargaining, depression, and acceptance.
Death education is education about death that focuses on the human and emotional aspects of death. Though it may include teaching on the biological aspects of death, teaching about coping with grief is a primary focus. The scientific study of death is known as thanatology. Thanatology stems from the Greek word thanatos, meaning death, and ology meaning a science or organized body of knowledge. A specialist in this field is a thanatologist.
Complex post-traumatic stress disorder is a stress-related mental and behavioral disorder generally occurring in response to complex traumas.
Disenfranchised grief is a term coined by Dr. Kenneth J. Doka in 1989. The concept describes the fact that some forms of grief are not acknowledged on a personal or societal level in modern Eurocentric culture. People might not like how you may or may not be expressing your grief or view your loss as insignificant, and thus they may feel uncomfortable, or judgmental. This is not a conscious way of thinking for most individuals, as it is deeply engrained in our psyche. This can be extremely isolating, and push you to question the depth of your grief and the loss you’ve experienced. This concept is viewed as a "type of grief", but it more so can be viewed as a "side effect" of grief. This also is not only applicable to grief in the case of death, but also the many other forms of grief. There are few support systems, rituals, traditions, or institutions such as bereavement leave available to those experiencing grief and loss.
Grief counseling is a form of psychotherapy that aims to help people cope with the physical, emotional, social, spiritual, and cognitive responses to loss. These experiences are commonly thought to be brought on by a loved person's death, but may more broadly be understood as shaped by any significant life-altering loss.
The terms delayed grief and unresolved grief are variations of grieving after a loss. The meaning of unresolved grief is any aspect of grieving that has yet to be resolved.
An informal or primary caregiver is an individual in a cancer patient's life that provides unpaid assistance and cancer-related care. Caregiving is defined as the processing of assisting someone who can't care for themselves, which includes physical, mental, emotional, social, and spiritual needs. Due to the typically late onset of cancer, caregivers are often the spouses and/or children of patients, but may also be parents, other family members, or close friends. Taking care of family members at home is a complicated experience. The relationships involved constantly shift and change, in expected and unexpected ways. The expected or expected changes can negatively affect physical health, emotions, social life, and spiritual well-being of the caregiver. Informal caregivers are a major form of support for the cancer patient because they provide most care outside of the hospital environment. This support includes:
Prolonged grief disorder (PGD), also known as complicated grief (CG), traumatic grief (TG) and persistent complex bereavement disorder (PCBD) in the DSM-5, is a mental disorder consisting of a distinct set of symptoms following the death of a family member or close friend. People with PGD are preoccupied by grief and feelings of loss to the point of clinically significant distress and impairment, which can manifest in a variety of symptoms including depression, emotional pain, emotional numbness, loneliness, identity disturbance and difficulty in managing interpersonal relationships. Difficulty accepting the loss is also common, which can present as rumination about the death, a strong desire for reunion with the departed, or disbelief that the death occurred. PGD is estimated to be experienced by about 10 percent of bereaved survivors, although rates vary substantially depending on populations sampled and definitions used.
Ambiguous loss is a loss that occurs without a significant likelihood of reaching emotional closure or a clear understanding. This kind of loss leaves a person searching for answers, and thus complicates and delays the process of grieving, and often results in unresolved grief. Causes include infertility, termination of pregnancy, disappearance of a family member, death of an ex-spouse, and a family member being physically alive but in a state of cognitive decline due to Alzheimer's disease.
Lorraine Kember is an Australian author, blogger, caregiver advocate, and an inspirational and motivational speaker.
Tu Nidito, meaning “your little nest” in Spanish, is a non-profit agency in Tucson, Arizona that provides support for children affected by serious medical conditions and death. The programs they offer include grief support for children and young adults that have experienced the death of a loved one, support for children with serious medical conditions, and support for children and teenagers that have a parent diagnosed with a serious medical condition, such as cancer.
The dual process model of coping is a model for coping with grief developed by Margaret Stroebe and Henk Schut. This model seeks to address shortcomings of prior models of coping, and provide a framework that better represents the natural variation in coping experience on a day to day basis.
Miscarriage and grief are both an event and subsequent process of grieving that develops in response to a miscarriage. Almost all those experiencing a miscarriage experience grief. This event is often considered to be identical to the death of a child and has been described as traumatic. "Devastation" is another descriptor of miscarriage. Grief is a profound, intensely personal sadness stemming from irreplaceable loss, often associated with sorrow, heartache, anguish, and heartbreak. Sadness is an emotion along with grief, on the other hand, is a response to the loss of the bond or affection was formed and is a process rather than one single emotional response. Grief is not equivalent to depression. Grief also has physical, cognitive, behavioral, social, cultural, and philosophical dimensions. Bereavement and mourning refer to the ongoing state of loss, and grief is the reaction to that loss. Emotional responses may be bitterness, anxiety, anger, surprise, fear, and disgust and blaming others; these responses may persist for months. Self-esteem can be diminished as another response to miscarriage. Not only does miscarriage tend to be a traumatic event, women describe their treatment afterwards to be worse than the miscarriage itself.
Child bereavement occurs when a child loses someone of importance in their life. There is substantial research regarding grief in adults, but there is less focus in literature about grief among children. Children will experience instances in their life that could involve losing a parent, sibling, or friend through suicide, unintentional injury, homicide, or natural causes. The levels of grief and bereavement differ among children, including uncomplicated and complicated bereavement. Unlike adults, children may experience and express their grief and bereavement through behaviors, and are less likely to outwardly express their emotions. The children who experience bereavement and grief can receive treatment involving group intervention, play therapy, and cognitive behavioral therapy. Different forms of treatment for children experiencing bereavement and or grief can help to reduce symptoms of anxiety, depression, social adjustment, and posttraumatic stress. Research has shown that it is important to be aware of the difficulties in predicting how losing a closed one can impact a child’s emotionality and how their coping abilities will differ across ages and cultures.
Mental disorders can be a consequence of miscarriage or early pregnancy loss. Even though women can develop long-term psychiatric symptoms after a miscarriage, acknowledging the potential of mental illness is not usually considered. A mental illness can develop in women who have experienced one or more miscarriages after the event or even years later. Some data suggest that men and women can be affected up to 15 years after the loss. Though recognized as a public health problem, studies investigating the mental health status of women following miscarriage are still lacking. Posttraumatic stress disorder (PTSD) can develop in women who have experienced a miscarriage. Risks for developing PTSD after miscarriage include emotional pain, expressions of emotion, and low levels of social support. Even if relatively low levels of stress occur after the miscarriage, symptoms of PTSD including flashbacks, intrusive thoughts, dissociation and hyperarousal can later develop. Clinical depression also is associated with miscarriage. Past responses by clinicians have been to prescribe sedatives.
Perinatal bereavement or perinatal grief refers to the emotions of the family following a perinatal death, defined as the demise of a fetus or newborn infant. Perinatal loss affects one in every ten women across the globe with the worldwide perinatal death rate at approximately 2.7 million deaths per year. Perinatal death is recognized as a traumatic life event as it is often sudden, unexpected, and devastating to parents who have had little to no direct life experiences with their child before their death.