Anticipatory grief

The nature of anticipatory grief

Anticipatory grief is a grief process that begins before a loved one's death. The concept was first described in 1944 in the research of psychiatrist Erich Lindemann. Anticipatory grief is typically experienced when a loved one has incurable cancer, a progressive memory disorder, ALS or another life-threatening illness. The grief is directed both at the future final loss and at the losses the illness is already causing: the familiar personality changing, shared plans falling through and daily life being transformed.

Anticipatory grief is not limited to family members. The person who is ill can also grieve their own coming death, lost health and the roles they must relinquish. Healthcare staff often experience similar feelings with long-term patients. Anticipatory grief is a normal reaction, not a sign of weakness or giving up.

Symptoms and recognition

The symptoms of anticipatory grief resemble post-death grief but have distinctive features. Typical symptoms include intense anxiety about the future loss, tearfulness, insomnia, concentration difficulties and withdrawal from social relationships. The family member may feel guilty about grieving before death, which can lead to suppressing emotions. Anger towards the illness, the healthcare system or fate is also common.

Particularly heavy anticipatory grief is associated with memory disorders, in which the loved one is physically present but their personality gradually changes. This is sometimes called the ambiguous loss phenomenon. The family member grieves a person who is simultaneously present and absent. This contradiction makes grief work particularly burdensome.

Support and coping strategies

It is important to receive support for anticipatory grief in good time. Social workers and psychologists working in hospice units specialise in supporting family members. Parish pastoral counsellors offer conversation support, and in peer support groups one can share experiences with others in a similar situation. MIELI ry's crisis helpline (09 2525 0111) operates around the clock.

Coping strategies include putting feelings into words and sharing them, keeping a diary, maintaining daily routines and taking care of one's own wellbeing. Many family members find it meaningful to spend the remaining time with their loved one as fully as possible. Arranging practical matters, such as a continuing power of attorney and advance directive, can also bring a sense of control in an uncertain situation.

Anticipatory grief and post-death grief

Anticipatory grief does not replace post-death grief. Although the family member has processed the loss in advance, death brings a new phase of grief. On the other hand, anticipatory grief can provide an opportunity to say goodbye and deal with unfinished business, which may ease post-death adjustment. If anticipatory grief has been particularly prolonged or exhausting, it is worth monitoring that it does not lead to complicated grief after the loss.