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 scheduled mastectomy, 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, it is important to note that 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 doesn't 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 expression of an experience that is the consequence of an event in life involving loss, causing grief, occurring as a result of someone's death, specifically someone who was loved although loss from death is not exclusively the cause of all experience of grief.
Grief is the response to loss, particularly to the loss of someone or some living thing that has died, 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.
Palliative care, aka comfort care, is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Within the published literature, many definitions of palliative care exist. The World Health Organization (WHO) describes palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual." In the past, palliative care was a disease specific approach, but today the WHO takes a more broad approach, that the principles of palliative care should be applied as early as possible to any chronic and ultimately fatal illness.
Terminal illness or end-stage disease is a disease that cannot be cured or adequately treated and is reasonably expected to result in the death of the patient. This term is more commonly used for progressive diseases such as cancer, dementia or advanced heart disease 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. Life expectancy for terminal patients is a rough estimate given by the physician based on previous data and does not always reflect true longevity. An illness which is lifelong but not fatal is a chronic condition.
The five stages of grief model states that those experiencing grief go through a series of five emotions: denial, anger, bargaining, depression and acceptance. Although commonly referenced in popular culture, studies have not empirically demonstrated the existence of these stages, and the model has been considered by some to be outdated and unhelpful in explaining the grieving process.
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. Death education is formally 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 referred to as a thanatologist. Death education refers to the experiences and activities of death that one deals with. Death education also deals with being able to grasp the different processes of dying, talk about the main topics of attitudes and meanings toward death, and the after effects on how to learn to care for people who are affected by the death. The main focus in death education is teaching people how to cope with grief. Many people feel death education is taboo and instead of talking about death and grieving, they hide it away and never bring it up with others. With the right education about death, the less taboo it may become.
Complex post-traumatic stress disorder is a psychological disorder that can develop in response to exposure to an extremely traumatic series of events in a context in which the individual perceives little or no chance of escape, and particularly where the exposure is prolonged or repetitive. In addition to the symptoms of post-traumatic stress disorder (PTSD), an individual with C-PTSD experiences emotional dysregulation, negative self-beliefs and feelings of shame, guilt or failure regarding the trauma, and interpersonal difficulties. C-PTSD relates to the trauma model of mental disorders and is associated with chronic sexual, psychological, and physical abuse or neglect, or chronic intimate partner violence, victims of kidnapping and hostage situations, indentured servants, victims of slavery and human trafficking, sweatshop workers, prisoners of war, concentration camp survivors, residential school survivors and prisoners kept in solitary confinement for a long period of time, or defectors from authoritarian religions. It is most often directed at children and emotionally vulnerable adults, and whilst motivations behind such abuse vary, though mostly being predominantly malicious, it has also been shown that the motivations behind such abuse can occasionally be well-intentioned. Situations involving captivity/entrapment can lead to C-PTSD-like symptoms, which can include prolonged feelings of terror, worthlessness, helplessness, and deformation of one's identity and sense of self.
Disenfranchised grief is a term describing grief that is not acknowledged as legitimate by society. For example, a loss may be seen as too small or the relationship too distant to justify grieving. Traditional forms of grief are more widely recognized and supported. There are few support systems, rituals, traditions, or institutions such as bereavement leave available to those experiencing disenfranchised grief.
A caregiver is a paid or unpaid member of a person's social network who helps them with activities of daily living. Since they have no specific professional training, they are often described as informal caregivers. Caregivers most commonly assist with impairments related to old age, disability, a disease, or a mental disorder.
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. 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. 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. Some examples are infertility, termination of pregnancy, disappearance of a family member, death of an ex-spouse, a family member being physically alive but in a state of cognitive decline due to Alzheimer's disease or dementia, etc. An ambiguous loss can be categorized into two types of loss: physical or psychological. Physical loss and psychological loss differ in terms of what is being grieved for, the loss of the physical body, or the psychological mind. Experiencing an ambiguous loss can lead to personal questions, such as, "Am I still married to my missing spouse?," or "Am I still a child to a parent who no longer remembers me?". Since the grief process in an ambiguous loss is halted, it is harder to cope or move on to acceptance from the type of loss experienced. There are various types of grief that can occur due to the type of ambiguity experienced and corresponding therapy techniques to address the certain types of grief. The overall goal of therapy to cope with ambiguous loss is to overcome the trauma associated with it and restore resilience.
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. They studied grief in their work "The Dual Process Model of Coping with Bereavement: A Decade On". It examines this model of coping and how it could be of benefit compared to others.
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 loss of a child and has been described as traumatic. But the vast majority of those who have suffered both will tell you they are nothing alike. Losing a child is in a category of its own when it comes to grief. "Devastation" is another descriptor of miscarriage. Grief differs from the emotion sadness. 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 illness 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.