Anticipatory Grief

The Grief Assessment and Intervention Workbook: A Strengths Perspective

Anticipatory grief is a rather new concept. According to the Encyclopedia of Death and Dying, psychiatrist Eric Lindemann was the first to describe the concept of anticipatory grief, and perhaps he was seeing the impact of families worried about their sons and daughters serving in WWII.

Lindemann defined anticipatory grief, "as a progression through the stages of grief, including depression, heightened preoccupation with the departed, a review of all the forms of death which might befall him, and anticipation of the modes of readjustment which might be necessitated by it."

Lindemann pointed out both advantages and disadvantages to anticipatory grief, with a major disadvantage being a premature withdrawal from the dying person.

The Encyclopedia points out that this concept represents an issue which is growing in importance since advanced medical technology is stretching the amount of time between diagnosis and and death.

The authors say, "Because of medical advances, dying has become more of a gradual process; debilitation is extended and quality of life has improved. There is a longer time during which families and the patient can experience anticipatory grief."

More recent authors like Therese A. Rando have defined anticipatory grief as "the phenomenon encompassing the process of mourning, coping, interaction, planning, psychosocial reorganization that are stimulated and begin in part in response to the awareness of the impending loss of a loved one." (Rando 1986, p.24).

There is disagreement in the literature about the impact of anticipatory grief on the grief process which happens after the actual death.

Some experts say anticipatory grief makes post death grief shorter, other experts say anticipatory grief enhances premature detachment and abandonment of the patient as death approaches.

Anticipatory grief can facilitate the process of talking about unfinished business in life, and death can then happen in a more peaceful manner.

Phases in Anticipatory Grief

Phases of anticipatory grief can parallel the Kubler-Ross stages, according to Beverly Rapheal, who wrote "The Anatomy of Bereavement" in 1983.

She reports that anticipatory grief is a process which takes time to develop, and both the patient and the family of the patient will progress through the process.

During this process the work is to slowly dispel the denial and to develop an awareness fo what is happening. The goal is to use anticipatory grief to reach a level of benefit, which is typically seen to be six to eighteen months for the survivors.

Anticipatory Grief in Special Circumstances

In certain circumstances, the advantages and disadvantages of anticipatory grief might be questioned, for example when a parent is dying, and the child's developmental level impedes the benefits of anticipatory grief, leading to poorer mental health outcomes for the child.

For parents anticipating the loss of a child, measurement of the benefit of anticipatory grief is unknown.

Anticipatory Grief and Alzheimers

The losses from Alzheimer's disease can be mitigated by anticipatory grief, although the care giver faces multiple losses across time from dementia, including perhaps not being able to care for the loved one at some point.

Anticipatory Grief and AIDS

Anticipatory grief for AIDS sufferers and their caregivers can run a similar course to that followed by caregivers for those suffering from dementia, and can be complicated because their relationdship may not be culturally approved.

For practioners working with patients and caregivers, the challenge is to combine the various elements of anticipatory grief, and to recognize that caregivers may or may not pull away, that anticipatory grief has stages, and caregivers experience multiple losses, and everyone gets a chance to work through "unfinished business."

Discussion of the emotional issues of fear, loss, and anger can help caregiver and patient to stay connected.

The goal is detachment from the patient and let go of the patient.

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When I was beginning my personal growth journey, a wise person told me that when I was feeling resentful or afraid or sad, that I should remember the phrase "gratitude is the attitude" when I was ready to feel better. That phrase has helped me feel better tens of thousands of times.

Would you share what you are most grateful for? Your story could be just what another person is searching for to renew themselves? Thanks.

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